Healthcare Provider Details

I. General information

NPI: 1083968184
Provider Name (Legal Business Name): JAIME LYN MCMILLAN M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9018 SW 100TH TER
GAINESVILLE FL
32608-5963
US

IV. Provider business mailing address

9018 SW 100TH TER
GAINESVILLE FL
32608-5963
US

V. Phone/Fax

Practice location:
  • Phone: 352-222-9104
  • Fax:
Mailing address:
  • Phone: 352-222-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: