Provider Demographics
NPI:1730602749
Name:ALTMAN, MIRANDA (FNP-C)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8214 MILWAUKEE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0923
Mailing Address - Country:US
Mailing Address - Phone:806-475-5544
Mailing Address - Fax:806-475-5545
Practice Address - Street 1:4642 N LOOP 289 STE 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2422
Practice Address - Country:US
Practice Address - Phone:806-797-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily