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NPI Code Detail

MEDICARE: KENNISHA BROOKE MIRANDA APRN

MEDICARE: KENNISHA BROOKE MIRANDA APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN11043507FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083584775
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNISHA BROOKE MIRANDA APRN
Provider Business Mailing Address
First Line : 1926 SW 42ND AVE
Second Line :
City : GAINESVILLE
State : FL
Zip : 32608-4087
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 SW ARCHER RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-3003
Country : US
Telephone Number : 352-265-8940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2025
Last Update Date : 01/06/2026

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Directions to “ KENNISHA BROOKE MIRANDA APRN” Practice Location

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