MEDICARE: KRISTIN 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
1	207Q00000X	Family Medicine Physician	APRN11008304	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1215504568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MIRANDA APRN

Provider Business Mailing Address
First Line	:	425 S HUNT CLUB BLVD STE 1051
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-2428
Country	:	US
Telephone Number	:	407-786-4080
Fax Number	:	407-786-4667

Provider Business Practice Location Address
First Line	:	737 STIRLING CENTER PL STE 1809
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5715
Country	:	US
Telephone Number	:	407-878-6008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	01/19/2025

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