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General NPI Number Information
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NPI Number | 1740567635
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Entity Type | Organization
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Legal Business Name | MIRA CONSULTING LLC
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 4055 SAVANNAHS TRL
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-8606
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Country | US
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Telephone | 321-208-8135
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Fax |
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Provider Business Mailing Address
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Address Line | 4055 SAVANNAHS TRL
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-8606
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Country | US
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Telephone | 321-208-8135
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SARA THERESA TURNER
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Credential | NP FAMILY PRACTICE
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Telephone | 609-442-8381
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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 | SP007727
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NO08707800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9316380
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN542932
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License Number State | PA
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