Healthcare Provider Details

I. General information

NPI: 1093003220
Provider Name (Legal Business Name): SOFIA MIRANDA ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62 AVE
MIAMI FL
33155-3073
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 305-622-8360
  • Fax:
Mailing address:
  • Phone: 305-661-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 5152354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: