Provider Demographics
NPI:1477796217
Name:GARCIA, MIRANDA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MIRANDA
Other - Middle Name:L
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 23584
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29925-3584
Mailing Address - Country:US
Mailing Address - Phone:843-342-9100
Mailing Address - Fax:
Practice Address - Street 1:12 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926
Practice Address - Country:US
Practice Address - Phone:843-342-9100
Practice Address - Fax:843-342-9101
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002889363AS0400X
GA6038363AS0400X
SC2992363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000613877OtherANTHEM
OHWAPA33341Medicare PIN