MEDICARE: EVENIE FRANTZDIA MIRALLES MSN, APRN, AGACNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	APRN11038500	FL
2	363LA2100X	Acute Care Nurse Practitioner	APRN11038500	FL
3	363LG0600X	Gerontology Nurse Practitioner	APRN11038500	FL

General Provider Information

NPI Number	:	1790588408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVENIE FRANTZDIA MIRALLES MSN, APRN, AGACNP-BC

Provider Business Mailing Address
First Line	:	8725 AZALEA CT APT 203
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-2043
Country	:	US
Telephone Number	:	786-930-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	8725 AZALEA CT APT 203
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-2043
Country	:	US
Telephone Number	:	786-930-8181
Fax Number	:

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	01/06/2026

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