Provider Demographics
NPI:1235648882
Name:MIRANDA, MELISSA (ARNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MIRANDA-LUCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2352 BRUCE B DOWNS BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9203
Practice Address - Country:US
Practice Address - Phone:813-528-4843
Practice Address - Fax:813-355-5052
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9310541363LF0000X
FLAPRN9310541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022469100Medicaid