Provider Demographics
NPI:1952917502
Name:TALMAGE, MIRANDA EDDY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:EDDY
Last Name:TALMAGE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BIRCHALL LN APT 306
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-6444
Mailing Address - Country:US
Mailing Address - Phone:205-317-7175
Mailing Address - Fax:
Practice Address - Street 1:1508 COGSWELL AVE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1243
Practice Address - Country:US
Practice Address - Phone:256-418-4300
Practice Address - Fax:888-827-8932
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-144300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics