Provider Demographics
NPI:1205517463
Name:MONROE, MIRANDA (MCLA, CVT, ACLS, BLS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:MCLA, CVT, ACLS, BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 69TH ST E STE 118
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-9478
Mailing Address - Country:US
Mailing Address - Phone:800-957-8593
Mailing Address - Fax:833-542-3024
Practice Address - Street 1:5281 69TH ST E STE 118
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-9478
Practice Address - Country:US
Practice Address - Phone:800-957-8593
Practice Address - Fax:833-542-3024
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy