Healthcare Provider Details

I. General information

NPI: 1639742497
Provider Name (Legal Business Name): ASHTIN ELIZABETH MIRAGLIA MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 WAVETREE DR
ROSWELL GA
30075-2944
US

IV. Provider business mailing address

185 WAVETREE DR
ROSWELL GA
30075-2944
US

V. Phone/Fax

Practice location:
  • Phone: 678-896-9266
  • Fax:
Mailing address:
  • Phone: 678-896-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN260109
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN260109
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: