Provider Demographics
NPI:1578383485
Name:MIRANDA, JANEEH MARIE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JANEEH MARIE
Middle Name:
Last Name:MIRANDA
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 1:701 SOUTHAMPTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2076
Mailing Address - Country:US
Mailing Address - Phone:415-579-6722
Mailing Address - Fax:
Practice Address - Street 1:701 SOUTHAMPTON RD STE 104
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2076
Practice Address - Country:US
Practice Address - Phone:415-579-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily