Basic Information
| Provider Information | |||||||||
| NPI: | 1093073454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA MEDINA | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | FRANCHESKA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25487 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342772487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412590926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4160 N ARMENIA AVE STE A | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136738245 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME136388 | FL | Y | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 27872 | NE | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.