Basic Information
| Provider Information | |||||||||
| NPI: | 1154078103 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MAXMILLIAN | ||||||||
| FirstName: | NIMMI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10107 TUSCAN SUN AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335789308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132203122 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2020 TOWN CENTER BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335112906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136331980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2022 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN11018577 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.