Provider Demographics
NPI:1740567635
Name:MIRA CONSULTING LLC
Entity Type:Organization
Organization Name:MIRA CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP FAMILY PRACTICE
Authorized Official - Phone:609-442-8381
Mailing Address - Street 1:4055 SAVANNAHS TRL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-8606
Mailing Address - Country:US
Mailing Address - Phone:321-208-8135
Mailing Address - Fax:
Practice Address - Street 1:4055 SAVANNAHS TRL
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8606
Practice Address - Country:US
Practice Address - Phone:321-208-8135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08707800163W00000X
FLRN9316380163W00000X
PARN542932163W00000X
PASP007727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty