Healthcare Provider Details

I. General information

NPI: 1861157737
Provider Name (Legal Business Name): MR. AUSTIN M MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 WEST CYPRESS CREEK ROAD
FORT LAUDERDALE FL
33309
US

IV. Provider business mailing address

2201 DUMAS DR
DELTONA FL
32738-5008
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-5000
  • Fax:
Mailing address:
  • Phone: 386-216-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11030984
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1191349
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: