Provider Demographics
NPI:1336202076
Name:MIRANDA, FABIANA GARCIA (WSC)
Entity Type:Individual
Prefix:MRS
First Name:FABIANA
Middle Name:GARCIA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:WSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 WISTER CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-5641
Mailing Address - Country:US
Mailing Address - Phone:813-760-5013
Mailing Address - Fax:
Practice Address - Street 1:3025 WISTER CIR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-5641
Practice Address - Country:US
Practice Address - Phone:813-760-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator