Provider Demographics
NPI:1255959383
Name:MIRABILE, LAUREN ASHLEY (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:MIRABILE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:MIRABILE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3259 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4342
Mailing Address - Country:US
Mailing Address - Phone:516-497-0048
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-562-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431758363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care