Healthcare Provider Details

I. General information

NPI: 1215504568
Provider Name (Legal Business Name): KRISTIN MIRANDA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 STIRLING CENTER PL STE 1809
LAKE MARY FL
32746-5715
US

IV. Provider business mailing address

425 S HUNT CLUB BLVD STE 1051
APOPKA FL
32703-2428
US

V. Phone/Fax

Practice location:
  • Phone: 407-878-6008
  • Fax:
Mailing address:
  • Phone: 407-786-4080
  • Fax: 407-786-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11008304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: