Provider Demographics
NPI:1134514870
Name:WHITE, MYRA KIM (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:KIM
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 STEVE SMITH WAY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209
Mailing Address - Country:US
Mailing Address - Phone:940-365-3032
Mailing Address - Fax:940-365-3032
Practice Address - Street 1:4930 E LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5003
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:321-249-0462
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9371525367A00000X
TX1049133367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015724500Medicaid
FLARNP9371525OtherSTATE LICENSE
FLIG025ZMedicare PIN