Healthcare Provider Details

I. General information

NPI: 1528305612
Provider Name (Legal Business Name): MELISSA LYNN MILLS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 73RD ST
SOUTH MIAMI FL
33143-4679
US

IV. Provider business mailing address

90 EDGEWATER DR UNIT 411
CORAL GABLES FL
33133-6942
US

V. Phone/Fax

Practice location:
  • Phone: 305-796-3490
  • Fax:
Mailing address:
  • Phone: 305-796-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9234094
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9234094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: