Healthcare Provider Details

I. General information

NPI: 1740567635
Provider Name (Legal Business Name): MIRA CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SAVANNAHS TRL
MERRITT ISLAND FL
32953-8606
US

IV. Provider business mailing address

4055 SAVANNAHS TRL
MERRITT ISLAND FL
32953-8606
US

V. Phone/Fax

Practice location:
  • Phone: 321-208-8135
  • Fax:
Mailing address:
  • Phone: 321-208-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007727
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO08707800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9316380
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN542932
License Number StatePA

VIII. Authorized Official

Name: MRS. SARA THERESA TURNER
Title or Position: OWNER
Credential: NP FAMILY PRACTICE
Phone: 609-442-8381