Provider Demographics
NPI:1477320232
Name:SVETKOVICH, MIRANDA S (NP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:S
Last Name:SVETKOVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3516
Mailing Address - Country:US
Mailing Address - Phone:931-762-9797
Mailing Address - Fax:931-762-9798
Practice Address - Street 1:326 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3516
Practice Address - Country:US
Practice Address - Phone:931-762-9797
Practice Address - Fax:931-762-9798
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF12230471363LF0000X
TN238487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily