Provider Demographics
NPI:1114237252
Name:REYES MIRANDA, ENIO (APRN)
Entity Type:Individual
Prefix:
First Name:ENIO
Middle Name:
Last Name:REYES MIRANDA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SW 94TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3072
Mailing Address - Country:US
Mailing Address - Phone:786-307-1876
Mailing Address - Fax:
Practice Address - Street 1:8370 W FLAGLER ST STE 242
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2040
Practice Address - Country:US
Practice Address - Phone:786-321-1600
Practice Address - Fax:786-744-7937
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9364263363LF0000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health