Healthcare Provider Details

I. General information

NPI: 1720845167
Provider Name (Legal Business Name): MIRANDA VEGA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 W TRENTON RD
EDINBURG TX
78539-3433
US

IV. Provider business mailing address

2703 W TRENTON RD
EDINBURG TX
78539-3433
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-9559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1151458
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: