Provider Demographics
NPI:1023041761
Name:ROMERO, JACQUELINE N (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:N
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11181 HEALTH PARK BLVD
Mailing Address - Street 2:STE 1170
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5734
Mailing Address - Country:US
Mailing Address - Phone:239-514-7315
Mailing Address - Fax:239-514-7304
Practice Address - Street 1:11181 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 2260
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5738
Practice Address - Country:US
Practice Address - Phone:239-514-7315
Practice Address - Fax:239-514-7304
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266107100Medicaid
FLH64281Medicare UPIN
FL51389ZMedicare ID - Type Unspecified