Individual
CRYSTAL YOUNG MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
400 CELEBRATION PL, CELEBRATION, FL 34747-4970
(407) 303-4000
Mailing address
400 CELEBRATION PL, CELEBRATION, FL 34747-4970
(407) 303-4000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9105266
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001550100
—
FL
01
—
P01270603
RR MEDICARE
FL
Enumeration date
10/21/2009
Last updated
08/28/2020
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