Healthcare Provider Details

I. General information

NPI: 1649884065
Provider Name (Legal Business Name): MIRANDA GAMGAH NJANTE APRN, FNP-PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10445 E PIVITOL AVE
MESA AZ
85212-8037
US

IV. Provider business mailing address

10445 E PIVITOL AVE
MESA AZ
85212-8037
US

V. Phone/Fax

Practice location:
  • Phone: 480-910-1539
  • Fax: 309-326-4439
Mailing address:
  • Phone: 510-355-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023057623
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number246767
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: