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NPI Code Detail

MEDICARE: MIRANDA ELIZABETH STEPHENS

MEDICARE: MIRANDA ELIZABETH STEPHENS
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1548051790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA ELIZABETH STEPHENS
Provider Business Mailing Address
First Line : 1015 ALTA DR
Second Line :
City : HOLLY HILL
State : FL
Zip : 32117-2614
Country : US
Telephone Number : 386-852-6321
Fax Number :
Provider Business Practice Location Address
First Line : 1251 N STONE ST
Second Line :
City : DELAND
State : FL
Zip : 32720-2584
Country : US
Telephone Number : 800-539-4228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2025
Last Update Date : 05/16/2025

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Directions to “ MIRANDA ELIZABETH STEPHENS ” Practice Location

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