Provider Demographics
NPI:1023599404
Name:MIRENDA, RONALD JAMES (FNP)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:MIRENDA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4681 GLEN LEVEL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6299
Mailing Address - Country:US
Mailing Address - Phone:706-580-7163
Mailing Address - Fax:
Practice Address - Street 1:299 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680
Practice Address - Country:US
Practice Address - Phone:770-867-2120
Practice Address - Fax:770-867-2140
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily