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Individual
MRS. LISA M MIRANDA
Active
Individual
MRS. LISA M MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15570
CA
363AM0700X
Medical Physician Assistant
PA1051
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0140208
UNITED HEALTHCARE
TN
01
—
2000307
BCBS OF TN
TN
05
—
3661837
—
TN
01
—
621038898
TAX ID
TN
01
—
970027904
RAILROAD MEDICARE
TN
01
—
FP62706
WORKERS COMP
TN
01
—
TN0102
JOHN DEERE
TN
Enumeration date
10/03/2006
Last updated
03/06/2019
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