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NPI Code Detail

MEDICARE: TRACI MARIE MIRAMONTES APRN

MEDICARE: TRACI MARIE MIRAMONTES 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 PractitionerAPRN11008757FL

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 : 1609493279
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACI MARIE MIRAMONTES APRN
Provider Business Mailing Address
First Line : 6041 SW 54TH ST
Second Line : STE 200
City : OCALA
State : FL
Zip : 34474-5521
Country : US
Telephone Number : 501-520-9972
Fax Number :
Provider Business Practice Location Address
First Line : 6038 W NORDLING LOOP
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-8715
Country : US
Telephone Number : 501-520-9972
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2020
Last Update Date : 09/20/2022

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Directions to “ TRACI MARIE MIRAMONTES APRN” Practice Location

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