MEDICARE: STACY MAYRENE MILLS APRN

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	363L00000X	Nurse Practitioner	APRN2748802	FL

General Provider Information

NPI Number	:	1679321970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY MAYRENE MILLS APRN

Provider Business Mailing Address
First Line	:	17504 PRESERVE WALK LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3243
Country	:	US
Telephone Number	:	813-549-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	17504 PRESERVE WALK LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3243
Country	:	US
Telephone Number	:	813-549-2299
Fax Number	:

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

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	05/10/2024

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