MEDICARE: MELISSA GISELA 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	F11230793	FL

General Provider Information

NPI Number	:	1396546156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GISELA MIRANDA APRN

Provider Business Mailing Address
First Line	:	1294 NW 159TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1625
Country	:	US
Telephone Number	:	954-654-0972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1294 NW 159TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1625
Country	:	US
Telephone Number	:	954-654-0972
Fax Number	:

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

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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