Provider Demographics
NPI:1881093607
Name:MIRANDA, MICHELLE (PMHNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KOBDISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1302 S SHIELDS ST UNIT A2-4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4803
Mailing Address - Country:US
Mailing Address - Phone:970-427-2820
Mailing Address - Fax:970-585-8169
Practice Address - Street 1:3800 AUTOMATION WAY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3449
Practice Address - Country:US
Practice Address - Phone:970-427-2820
Practice Address - Fax:970-585-8169
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125990363LP0808X
COC-APN.0000456-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health