Healthcare Provider Details

I. General information

NPI: 1407954936
Provider Name (Legal Business Name): MELANIE MILLER RN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

IV. Provider business mailing address

PO BOX 5849
HUDSON FL
34674-5849
US

V. Phone/Fax

Practice location:
  • Phone: 727-232-0644
  • Fax: 888-546-0488
Mailing address:
  • Phone: 727-861-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9103875
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103875
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103875
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: