Provider Demographics
NPI:1841690328
Name:MIRANDA, SARA DIANA (APN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DIANA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DIANA
Other - Last Name:ZAKARIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:645 S CENTRAL AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-5059
Mailing Address - Country:US
Mailing Address - Phone:773-537-0020
Mailing Address - Fax:773-537-0029
Practice Address - Street 1:5425 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2342
Practice Address - Country:US
Practice Address - Phone:773-378-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012136363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner