Provider Demographics
NPI:1285198861
Name:MIRAGLIA, JEANETTE R (DACM, DOM, AP)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:R
Last Name:MIRAGLIA
Suffix:
Gender:F
Credentials:DACM, DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 14TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1011
Mailing Address - Country:US
Mailing Address - Phone:941-350-9205
Mailing Address - Fax:
Practice Address - Street 1:5190 26TH ST W STE G
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2200
Practice Address - Country:US
Practice Address - Phone:941-896-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3843171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist