Healthcare Provider Details

I. General information

NPI: 1073240032
Provider Name (Legal Business Name): MARIA OFELIA MIRABAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 509
HIALEAH FL
33013-3834
US

IV. Provider business mailing address

245 NE 14TH ST APT 2007
MIAMI FL
33132-1622
US

V. Phone/Fax

Practice location:
  • Phone: 305-420-5016
  • Fax: 786-452-9901
Mailing address:
  • Phone: 305-420-5016
  • Fax: 786-452-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11019096
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11019096
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF03220698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: