Provider Demographics
NPI:1275330599
Name:MIAO, AUDREY (APRN)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:MIAO
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 W CAMP WISDOM RD STE 170
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4640
Mailing Address - Country:US
Mailing Address - Phone:972-645-5109
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:3040 W CAMP WISDOM RD STE 170
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4640
Practice Address - Country:US
Practice Address - Phone:972-645-5109
Practice Address - Fax:512-782-9316
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily