Healthcare Provider Details

I. General information

NPI: 1649557067
Provider Name (Legal Business Name): JILL M MILTENBERGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD STE 302
MELBOURNE FL
32940-2240
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9265
  • Fax: 321-434-9231
Mailing address:
  • Phone: 321-434-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9442449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: