Healthcare Provider Details

I. General information

NPI: 1073448783
Provider Name (Legal Business Name): EMILY ANN MINOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6064 NE DUSTY MILLER AVE
PINETTA FL
32350-2925
US

IV. Provider business mailing address

6064 NE DUSTY MILLER AVE
PINETTA FL
32350-2925
US

V. Phone/Fax

Practice location:
  • Phone: 386-362-3231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: