Individual
MIA JO TAVERONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10 STAFFORD LAKES PKWY STE 102, FREDERICKSBURG, VA 22406-7305
(540) 741-6982
Mailing address
1340 CENTRAL PARK BLVD STE 100, FREDERICKSBURG, VA 22401-4940
(540) 741-6982
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110011893
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/07/2026
Last updated
06/08/2026
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