Provider Demographics
NPI:1114521069
Name:TERRES, MIRANDA S (PA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:S
Last Name:TERRES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:S
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6376 PINE RIDGE RD UNIT 180
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3926
Mailing Address - Country:US
Mailing Address - Phone:239-263-0849
Mailing Address - Fax:239-263-2376
Practice Address - Street 1:6376 PINE RIDGE RD UNIT 180
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3926
Practice Address - Country:US
Practice Address - Phone:239-263-0849
Practice Address - Fax:239-263-2376
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant