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Individual

MIRANDA A BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
2230 PHOENIX AVE, JACKSONVILLE, FL 32206-3159
(904) 466-7339
Mailing address
1985 W 30TH ST, JACKSONVILLE, FL 32209-3787
(904) 466-7339

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9674808
FL
164W00000X
Licensed Practical Nurse
PN5169477
FL

Other

Enumeration date
07/04/2024
Last updated
05/19/2025
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