Provider Demographics
NPI:1437958519
Name:TAMANG, MIRA MAYA (NP)
Entity type:Individual
Prefix:
First Name:MIRA MAYA
Middle Name:
Last Name:TAMANG
Suffix:
Gender:X
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6985
Practice Address - Street 1:3604 LIVE OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6169
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6985
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182426363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX928784OtherRN LICENSE
TX1182426OtherNURSES LICENSE