Provider Demographics
NPI:1821685298
Name:MIROWSKI, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MIROWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MIROWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:522 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-6407
Mailing Address - Country:US
Mailing Address - Phone:219-406-1519
Mailing Address - Fax:
Practice Address - Street 1:522 NW 31ST AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-6407
Practice Address - Country:US
Practice Address - Phone:219-406-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167711A163W00000X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11101968OtherNOTHING
IN8149OtherN/A
11101968OtherBDAY