Individual provider Active NPI

Tatyana Stanislavovna Miroshnikova, M.D.

  • Internal Medicine Physician
  • Orlando, FL
National Provider Identifier
1104990761
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 95451 Issued in FL
Practice address
9400 Turkey Lake Rd
MP 452
Orlando, FL 32819-8001
Phone
(321) 843-5500
Fax
(321) 843-5550
NPI assigned
Nov 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME 95451 FL Primary
Hospitalist Physician 208M00000X ME95451 FL

Addresses

Primary practice location

9400 Turkey Lake Rd
MP 452
Orlando, FL 32819-8001

Mailing address

9400 Turkey Lake Rd
MP 452
Orlando, FL 32819-8001
Phone (321) 843-5500

Other identifiers 2

IdentifierTypeStateIssuer
ME95451OtherFLMEDICAL LICENSE
002896300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100519000383 FL Practitioner - Internal Medicine 5395874069 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 95451FLMDInternal Medicine Physician
ME95451FLMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc Internal Medicine CurrentSince Dec 1, 2010 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Dec 1, 2010 Accepting new patients

Locations

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

9400 Turkey Lake Rd
#452
Orlando, FL 32819
Phone (321) 842-8505

9400 Turkey Lake Rd
Orlando, FL 32819
Phone (321) 843-5500

Interoperability endpoints

  • Direct secure messaging: tmiroshnikova26064@orlandohealth.medalliesdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1104990761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9400 TURKEY LAKE RD",
            "address_2": "MP 452",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198001",
            "telephone_number": "321-843-5500",
            "fax_number": "321-843-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 TURKEY LAKE RD",
            "address_2": "MP 452",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198001",
            "telephone_number": "321-843-5500",
            "fax_number": "321-843-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIROSHNIKOVA",
        "first_name": "TATYANA",
        "middle_name": "STANISLAVOVNA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 95451",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "ME95451",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME95451",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002896300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.