Provider Demographics
NPI:1861976995
Name:CASTANEDA, MIRANDA JEAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:JEAN
Last Name:CASTANEDA
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 1:6065 MONTANA AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1837
Mailing Address - Country:US
Mailing Address - Phone:760-550-8692
Mailing Address - Fax:
Practice Address - Street 1:6065 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1835
Practice Address - Country:US
Practice Address - Phone:915-771-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX908983163W00000X
TXF09181392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse