Provider Demographics
NPI:1215504568
Name:MIRANDA, KRISTIN (APRN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S HUNT CLUB BLVD STE 1051
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-2428
Mailing Address - Country:US
Mailing Address - Phone:407-786-4080
Mailing Address - Fax:407-786-4667
Practice Address - Street 1:737 STIRLING CENTER PL STE 1809
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5715
Practice Address - Country:US
Practice Address - Phone:407-878-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine