Provider Demographics
NPI:1285002162
Name:BERNAL, MIRANDA T (AA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:T
Last Name:BERNAL
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:T
Other - Last Name:ESPINDOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:7700 W SUNRISE BLVD
Mailing Address - Street 2:2ND FL- MAILSTOP PL-14
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4113
Mailing Address - Country:US
Mailing Address - Phone:954-939-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:305-596-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL367H00000X
FLAA306367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant