Provider Demographics
NPI:1780036301
Name:HOSMON, MIRIAM (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:HOSMON
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 MOUNT OLYMPUS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-2413
Mailing Address - Country:US
Mailing Address - Phone:359-822-8879
Mailing Address - Fax:
Practice Address - Street 1:421 N WOODLAND BLVD UNIT 8317
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32723-8417
Practice Address - Country:US
Practice Address - Phone:386-822-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer