Healthcare Provider Details

I. General information

NPI: 1174379978
Provider Name (Legal Business Name): EMILY MILLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 RIVERSIDE AVE
JACKSONVILLE FL
32204-4717
US

IV. Provider business mailing address

2627 RIVERSIDE AVE
JACKSONVILLE FL
32204-4717
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-7372
  • Fax: 904-308-2908
Mailing address:
  • Phone: 904-308-7372
  • Fax: 904-308-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberU9920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: