Healthcare Provider Details

I. General information

NPI: 1457262859
Provider Name (Legal Business Name): MIRANDA LEANN EASH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 NW AMERICAN LN
LAKE CITY FL
32055-4881
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 386-288-5311
  • Fax: 386-288-0058
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: