Healthcare Provider Details

I. General information

NPI: 1902201890
Provider Name (Legal Business Name): JARA MILLER MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST SPECIALTY NURSING DEPARTMENT
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

1400 E BOULDER ST SPECIALTY NURSING DEPARTMENT
COLORADO SPRINGS CO
80909-5533
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6744
  • Fax: 719-365-9907
Mailing address:
  • Phone: 719-365-6744
  • Fax: 719-365-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991485-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: