MEDICARE: MRS. VICTORIA O MILLER PA-C

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	363A00000X	Physician Assistant	PA9100960	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316946866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA O MILLER PA-C

Provider Business Mailing Address
First Line	:	493 PROSPERITY LAKE DR
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-5045
Country	:	US
Telephone Number	:	904-824-5437
Fax Number	:	904-824-7575

Provider Business Practice Location Address
First Line	:	493 PROSPERITY LAKE DR
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-5045
Country	:	US
Telephone Number	:	904-824-5437
Fax Number	:	904-824-7575

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/17/2012

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