Healthcare Provider Details

I. General information

NPI: 1295191096
Provider Name (Legal Business Name): ANTHONY MILANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12735 GRAN BAY PKWY W STE 204
JACKSONVILLE FL
32258-4499
US

IV. Provider business mailing address

12735 GRAN BAY PKWY W STE 204
JACKSONVILLE FL
32258-4499
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax:
Mailing address:
  • Phone: 888-754-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: