MEDICARE: MS. FAITH MARIE MILES BA

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

General Provider Information

NPI Number	:	1992891337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FAITH MARIE MILES BA

Provider Business Mailing Address
First Line	:	12016 N OREGON AVENUE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-4017
Country	:	US
Telephone Number	:	813-673-4622
Fax Number	:	813-673-4631

Provider Business Practice Location Address
First Line	:	2313 W VIOLET ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603
Country	:	US
Telephone Number	:	813-673-4622
Fax Number	:	813-673-4631

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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