Healthcare Provider Details

I. General information

NPI: 1447515366
Provider Name (Legal Business Name): ALINA D MIRACLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W SAGAMORE AVE
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

500 W SAGAMORE AVE
CLEWISTON FL
33440-3514
US

V. Phone/Fax

Practice location:
  • Phone: 863-983-3434
  • Fax: 863-983-6655
Mailing address:
  • Phone: 863-983-3434
  • Fax: 863-983-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2158932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: