Healthcare Provider Details

I. General information

NPI: 1578015269
Provider Name (Legal Business Name): AMANDA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

IV. Provider business mailing address

2659 GREEN MEADOW LN NE
MARIETTA GA
30066-5648
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-7584
  • Fax:
Mailing address:
  • Phone: 770-875-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000200179
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN212795
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9453318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: