Provider Demographics
NPI:1790497600
Name:MIRANDA, TATIANA NICOLE
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:NICOLE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13770 SW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3704
Mailing Address - Country:US
Mailing Address - Phone:786-266-4096
Mailing Address - Fax:
Practice Address - Street 1:55 SE 5TH ST
Practice Address - Street 2:#3307
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131
Practice Address - Country:US
Practice Address - Phone:786-660-1852
Practice Address - Fax:786-524-4680
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician