Healthcare Provider Details

I. General information

NPI: 1114059169
Provider Name (Legal Business Name): MARY KATHLEEN MILLER DNP, CNM, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

13300 GULF BLVD APT C
MADEIRA BEACH FL
33708-2502
US

V. Phone/Fax

Practice location:
  • Phone: 321-834-8164
  • Fax: 407-389-5312
Mailing address:
  • Phone: 407-716-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP3211042
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN3211042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: