Healthcare Provider Details

I. General information

NPI: 1043940356
Provider Name (Legal Business Name): JAKAYLA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 RIDGEWOOD AVE
BRANDON FL
33510
US

IV. Provider business mailing address

4026 APRIL ST. N.
LAKELAND FL
33812
US

V. Phone/Fax

Practice location:
  • Phone: 813-816-1788
  • Fax:
Mailing address:
  • Phone: 813-816-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22002
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019099
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: