Provider Demographics
NPI:1972559250
Name:MIRANDA, MYRNA RONNIE (FNP)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:RONNIE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8914 BREANNA OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5703
Mailing Address - Country:US
Mailing Address - Phone:915-373-0725
Mailing Address - Fax:
Practice Address - Street 1:8914 BREANNA OAKS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254
Practice Address - Country:US
Practice Address - Phone:915-373-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily