MEDICARE: HEATHER MICHELLE MILLER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	TMP-160810	KS
2	363LF0000X	Family Nurse Practitioner	APRN11039008	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TMP-160810	OTHER	KS	CERTIFIED NURSE PRACTITIONER

General Provider Information

NPI Number	:	1053057174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MICHELLE MILLER NP

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-217-7469

Provider Business Practice Location Address
First Line	:	6900 DANIELS PKWY STE 23A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-1586
Country	:	US
Telephone Number	:	239-349-3539
Fax Number	:	239-217-7469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	11/05/2025

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