| Doctor Name: | MIRANDA R VINCENT |
| NPI Number: | 1003063884 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | A.P.R.N. |
| License Number: | 002406 |
| Business Practice Address: | 15 Corporate Dr Trumbull, CT - 066111351 |
| Business Phone Number: | 2034528322 |
| Business Fax Number: | |
| Mailing Address: | 459 Romanock Road, FAIRFIELD |
| State: | CT |
| Postal Code: | 06825 |
| Phone Number: | 2032923631 |
| Fax Number: | |
| NPI Enumeration Date: | 08/22/2008 |
| NPI Last Update Date: | 07/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 002406 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |