Healthcare Provider Details

I. General information

NPI: 1790331734
Provider Name (Legal Business Name): ARTURO MIRANDA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 W NEWBERRY RD STE B
GAINESVILLE FL
32605-4470
US

IV. Provider business mailing address

166 SW DRAGONFLY CT
LAKE CITY FL
32024-3674
US

V. Phone/Fax

Practice location:
  • Phone: 904-547-2574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11003704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: