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General NPI Number Information
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NPI Number | 1346872777
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Entity Type | Organization
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Legal Business Name | MIRAID, LLC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 19723 DEER LAKE RD
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City | LUTZ
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State | FL
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Zip | 33548-7203
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Country | US
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Telephone | 603-998-0342
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 KASS CIR
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City | SPRING HILL
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State | FL
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Zip | 34606-4308
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Country | US
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Telephone | 352-587-0321
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Fax | 352-616-1650
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Authorized Official
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Title or Position | OWNER AND DIRECTOR OF OPERATIONS
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Name | KIMBERLY COFFEY
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Credential | RN, MSN
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Telephone | 352-587-0321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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