MEDICARE: MIRANDA CONCEPCION LEAL FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	1011591	TX

General Provider Information

NPI Number	:	1821946559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA CONCEPCION LEAL FNP-C

Provider Business Mailing Address
First Line	:	3706 GOODWIN AVE UNIT 272
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78721-2489
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12415 N INTERSTATE 35
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-1326
Country	:	US
Telephone Number	:	737-205-1270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ MIRANDA CONCEPCION LEAL FNP-C” Practice Location

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