Provider Demographics
NPI:1952831380
Name:MAYCOCK-DOSS, MIRIAM JOY (ARNP)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:JOY
Last Name:MAYCOCK-DOSS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SE HILLMOOR DR STE 407
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7561
Mailing Address - Country:US
Mailing Address - Phone:772-335-9600
Mailing Address - Fax:772-398-7971
Practice Address - Street 1:1700 SE HILLMOOR DR STE 407
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7561
Practice Address - Country:US
Practice Address - Phone:772-335-9600
Practice Address - Fax:772-398-7971
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9287504363LF0000X
FLARNP9287504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily