Provider Demographics
NPI:1326388646
Name:MIRONOVA, NATALIA ALEXANDROVNA
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:ALEXANDROVNA
Last Name:MIRONOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 101ST ST
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1507
Mailing Address - Country:US
Mailing Address - Phone:305-586-1478
Mailing Address - Fax:
Practice Address - Street 1:3150 SW 38TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1512
Practice Address - Country:US
Practice Address - Phone:786-261-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9278659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner