Healthcare Provider Details

I. General information

NPI: 1760992317
Provider Name (Legal Business Name): CASEY MILLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD STE 221
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

40 SEVEN WONDERS TRL
PALM COAST FL
32164-5419
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberARNP9308693
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9308693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: