Healthcare Provider Details

I. General information

NPI: 1538540232
Provider Name (Legal Business Name): MEGAN MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 26TH ST W
BRADENTON FL
34207-3012
US

IV. Provider business mailing address

PO BOX 997
PALMETTO FL
34220-0997
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-8500
  • Fax: 941-708-8503
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-776-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9266895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: