Healthcare Provider Details

I. General information

NPI: 1003773334
Provider Name (Legal Business Name): KAYLA MIRANDA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 VETERANS PARK DR STE 103
NAPLES FL
34109-0446
US

IV. Provider business mailing address

1701 HIGHWAY A1A STE 300
VERO BEACH FL
32963-2263
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-5220
  • Fax: 239-596-5222
Mailing address:
  • Phone: 561-320-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11044488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: