Healthcare Provider Details

I. General information

NPI: 1558874875
Provider Name (Legal Business Name): MIRIAM ELISABETH ADDITON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6386
US

IV. Provider business mailing address

3216 W DE LEON ST UNIT 29
TAMPA FL
33609-5505
US

V. Phone/Fax

Practice location:
  • Phone: 813-541-1913
  • Fax:
Mailing address:
  • Phone: 813-541-1913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9363868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: