Provider Demographics
NPI:1285405738
Name:MANN, MIRANDA (NP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 VETERANS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6946
Mailing Address - Country:US
Mailing Address - Phone:865-428-2773
Mailing Address - Fax:
Practice Address - Street 1:1787 VETERANS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6946
Practice Address - Country:US
Practice Address - Phone:865-428-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily