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General NPI Number Information
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NPI Number | 1891580296
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Entity Type | Individual
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Provider Name | MIRANDA YACOVETTA CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 78 MEDICAL CENTER DR
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2332
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Country | US
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Telephone | 205-737-2942
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Fax |
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Provider Business Mailing Address
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Address Line | 7973 ELI CIR
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2472
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 11043472
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License Number State | FL
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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 | 1-171028
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024195612
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License Number State | VA
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