Healthcare Provider Details

I. General information

NPI: 1881918860
Provider Name (Legal Business Name): JUDYTH MIRANDA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2010
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 ALLEGRA WAY
LUTZ FL
33559-6999
US

IV. Provider business mailing address

2831 ALLEGRA WAY
LUTZ FL
33559-6999
US

V. Phone/Fax

Practice location:
  • Phone: 813-817-2847
  • Fax:
Mailing address:
  • Phone: 813-817-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9189175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: