Provider Demographics
NPI:1023122470
Name:MIRANDA, COLLEEN KRISTINA (CNP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:KRISTINA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2246
Mailing Address - Country:US
Mailing Address - Phone:937-475-8775
Mailing Address - Fax:
Practice Address - Street 1:4961 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8129
Practice Address - Country:US
Practice Address - Phone:937-475-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 204202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily