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General NPI Number Information
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NPI Number | 1609493279
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Entity Type | Individual
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Provider Name | TRACI MARIE MIRAMONTES APRN
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Gender | Female
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 6038 W NORDLING LOOP
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-8715
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Country | US
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Telephone | 501-520-9972
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Fax |
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Provider Business Mailing Address
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Address Line | 6041 SW 54TH ST STE 200
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City | OCALA
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State | FL
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Zip | 34474-5521
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Country | US
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Telephone | 501-520-9972
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11008757
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License Number State | FL
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