Healthcare Provider Details

I. General information

NPI: 1205517463
Provider Name (Legal Business Name): MIRANDA MONROE MCLA, CVT, ACLS, BLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5281 69TH ST E STE 118
PALMETTO FL
34221-9478
US

IV. Provider business mailing address

5281 69TH ST E STE 118
PALMETTO FL
34221-9478
US

V. Phone/Fax

Practice location:
  • Phone: 800-957-8593
  • Fax: 833-542-3024
Mailing address:
  • Phone: 800-957-8593
  • Fax: 833-542-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: