Provider Demographics
NPI:1215332838
Name:PANETTA, MIRANDA DAWN (ARNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DAWN
Last Name:PANETTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:DAWN
Other - Last Name:LAPPERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10561 SAN TRAVASO DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2919
Mailing Address - Country:US
Mailing Address - Phone:813-947-4828
Mailing Address - Fax:
Practice Address - Street 1:1523 W NORTH B ST UNIT 5
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1616
Practice Address - Country:US
Practice Address - Phone:813-389-9474
Practice Address - Fax:888-814-0945
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9387485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1306959507OtherGROUP NPI