Provider Demographics
NPI:1124896766
Name:MCWHIRTER, MIRANDA DENISE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DENISE
Last Name:MCWHIRTER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 YOSEMITE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8065
Mailing Address - Country:US
Mailing Address - Phone:727-605-3000
Mailing Address - Fax:
Practice Address - Street 1:14153 YOSEMITE DR STE 104
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8065
Practice Address - Country:US
Practice Address - Phone:727-605-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine