Provider Demographics
NPI:1639742497
Name:MIRAGLIA, ASHTIN ELIZABETH (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:ASHTIN
Middle Name:ELIZABETH
Last Name:MIRAGLIA
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 THREE BRANCHES CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5907
Mailing Address - Country:US
Mailing Address - Phone:678-896-9266
Mailing Address - Fax:
Practice Address - Street 1:409 THREE BRANCHES CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5907
Practice Address - Country:US
Practice Address - Phone:678-896-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN260109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily