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General NPI Number Information
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NPI Number | 1477905925
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Entity Type | Individual
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Provider Name | GINA MARIE MIRANDA PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 100 FEDERAL CITY RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1664
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Country | US
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Telephone | 609-620-1380
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Fax |
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Provider Business Mailing Address
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Address Line | 8 GORHAM CT
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City | JACKSON
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State | NJ
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Zip | 08527-6324
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00399000
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License Number State | NJ
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