Provider Demographics
NPI:1023343506
Name:QUINTANA, MIRANDA L (CNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 FOREST DR STE D
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7102
Mailing Address - Country:US
Mailing Address - Phone:614-933-9100
Mailing Address - Fax:614-933-9103
Practice Address - Street 1:5121 FOREST DR STE D
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7102
Practice Address - Country:US
Practice Address - Phone:614-933-9100
Practice Address - Fax:614-933-9103
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11115-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health