Basic Information
| Provider Information | |||||||||
| NPI: | 1639224793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORRELL-MILLER | ||||||||
| FirstName: | ROSLYN | ||||||||
| MiddleName: | KAREN | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14527 7TH ST | ||||||||
| Address2: | |||||||||
| City: | DADE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335233102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525211474 | ||||||||
| FaxNumber: | 3525210212 | ||||||||
| Practice Location | |||||||||
| Address1: | 14527 7TH ST | ||||||||
| Address2: | |||||||||
| City: | DADE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335233102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525211474 | ||||||||
| FaxNumber: | 3525210212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | ARNP1925732 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 163WP0808X | ARNP1925732 | FL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 761821200 | 05 | FL | MEDICAID |