Healthcare Provider Details

I. General information

NPI: 1275921678
Provider Name (Legal Business Name): MIRANDA SCHULZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3888 HIGHWAY 90
PACE FL
32571-1014
US

IV. Provider business mailing address

4669 CRAIG ST
MILTON FL
32583-3602
US

V. Phone/Fax

Practice location:
  • Phone: 850-994-2229
  • Fax:
Mailing address:
  • Phone: 850-266-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9324957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: