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General NPI Number Information
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NPI Number | 1598991234
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Entity Type | Individual
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Provider Name | LISA MIRANSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 8200 W SUNRISE BLVD # D-6
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City | PLANTATION
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State | FL
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Zip | 33322-5426
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Country | US
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Telephone | 954-475-1735
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Fax | 954-475-1741
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Provider Business Mailing Address
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Address Line | 8200 W SUNRISE BLVD # D-6
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City | PLANTATION
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State | FL
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Zip | 33322-5426
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Country | US
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Telephone | 954-475-1735
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Fax | 954-475-1741
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9104870
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License Number State | FL
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