Mis Provider Network LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MIS PROVIDER NETWORK LLC

Practice address

170 Fitzgerald Rd Ste 1
Lakeland, FL 33813-2633

Phone

(813) 687-5858

NPI assigned

Apr 20, 2022

Organization subpart

No

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

Authorized official

Name

Wendy L Bradshaw, MD

Title

Owner

Phone

(813) 687-5858

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1700529369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 FITZGERALD RD STE 1",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132633",
            "telephone_number": "813-687-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 FITZGERALD RD STE 1",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132633",
            "telephone_number": "813-687-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIS PROVIDER NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-20",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-687-5858",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zuylen De la Caridad Miranda Gonzalez
• Roberto Miranda-Quesda, APRN
• A'Lyse Mellys Miranda
• Diane Miranda
• Max Miranda, PA
• Misada Inc
• David Michael Misch, MD
• Magdalena Ewa Misiurek, MD
• Mission Health & Massage Inc.
• Deshawn Deloris Mitchell, APRN

• Family Medicine Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.