Healthcare Provider Details

I. General information

NPI: 1134533219
Provider Name (Legal Business Name): AMY LEIGH MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5796
US

IV. Provider business mailing address

201 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5796
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4043
  • Fax:
Mailing address:
  • Phone: 904-819-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: