Provider Demographics
NPI:1144941378
Name:MIRANDA CALNICK, KATIA
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:MIRANDA CALNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13292 SW 274TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8589
Mailing Address - Country:US
Mailing Address - Phone:786-547-3887
Mailing Address - Fax:
Practice Address - Street 1:13292 SW 274TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8589
Practice Address - Country:US
Practice Address - Phone:786-547-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF09220090363LF0000X
FLAPRN11022187363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF09220090OtherADVANCE REGISTERED NURSE PRACTITIONER