Provider Demographics
NPI:1356870257
Name:MIRANDA, ELIZABETH A (APN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6426
Mailing Address - Country:US
Mailing Address - Phone:551-221-0331
Mailing Address - Fax:
Practice Address - Street 1:2042 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6045
Practice Address - Country:US
Practice Address - Phone:908-206-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00736600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner