Healthcare Provider Details

I. General information

NPI: 1033808472
Provider Name (Legal Business Name): MILLIE YEAMANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY INPATIENT CLINICAL NUTRITION
ORLANDO FL
32827
US

IV. Provider business mailing address

3053 RISING MIST CT
KISSIMMEE FL
34744-8564
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-1845
  • Fax:
Mailing address:
  • Phone: 407-443-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND9513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: