Healthcare Provider Details

I. General information

NPI: 1588033948
Provider Name (Legal Business Name): LORI MILLINGEN AA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486
US

IV. Provider business mailing address

683 NW 88TH DR
CORAL SPRINGS FL
33071-7190
US

V. Phone/Fax

Practice location:
  • Phone: 386-589-1895
  • Fax:
Mailing address:
  • Phone: 386-589-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA-278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: