Healthcare Provider Details

I. General information

NPI: 1619387966
Provider Name (Legal Business Name): COURTNEY ANDONIA MCMILLIAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 AVIATION AVE SUITE 700
MIAMI FL
33133-4741
US

IV. Provider business mailing address

660 GLADES RD SUITE 420
BOCA RATON FL
33431-6465
US

V. Phone/Fax

Practice location:
  • Phone: 561-416-0103
  • Fax: 561-416-9896
Mailing address:
  • Phone: 561-416-0103
  • Fax: 561-416-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9234857
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number542129332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: