Basic Information
| Provider Information | |||||||||
| NPI: | 1174069454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 ARLINGTON EXPY APT 406 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322116864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043330721 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6639 SOUTHPOINT PKWY | ||||||||
| Address2: | STE 108 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322168041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044387640 | ||||||||
| FaxNumber: | 9044387656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2017 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN5209308 | FL | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.