MEDICARE: MIRA CONSULTING LLC

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	163W00000X	Registered Nurse	26NO08707800	NJ
2	163W00000X	Registered Nurse	RN9316380	FL
3	163W00000X	Registered Nurse	RN542932	PA
4	363LF0000X	Family Nurse Practitioner	SP007727	PA

General Provider Information

NPI Number	:	1740567635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRA CONSULTING LLC

Provider Business Mailing Address
First Line	:	4055 SAVANNAHS TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-8606
Country	:	US
Telephone Number	:	321-208-8135
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 SAVANNAHS TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-8606
Country	:	US
Telephone Number	:	321-208-8135
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SARA THERESA TURNER
Credential	:	NP FAMILY PRACTICE
Telephone Number	:	609-442-8381

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	11/07/2011

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Directions to “MIRA CONSULTING LLC ” Practice Location

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