MEDICARE: JADA LANITA MCMILLON

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	104100000X	Social Worker

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	:	1568474229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA LANITA MCMILLON

Provider Business Mailing Address
First Line	:	5118 N 56TH ST
Second Line	:	SUITE 224
City	:	TAMPA
State	:	FL
Zip	:	33610-5416
Country	:	US
Telephone Number	:	813-977-7677
Fax Number	:	813-977-5017

Provider Business Practice Location Address
First Line	:	5118 N 56TH ST
Second Line	:	SUITE 224
City	:	TAMPA
State	:	FL
Zip	:	33610-5416
Country	:	US
Telephone Number	:	813-977-7677
Fax Number	:	813-977-5017

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/23/2013

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Directions to “ JADA LANITA MCMILLON ” Practice Location

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