Healthcare Provider Details

I. General information

NPI: 1316665862
Provider Name (Legal Business Name): MICHAEL JOSEPH MILANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WHITEHALL DR
ST AUGUSTINE FL
32086-5269
US

IV. Provider business mailing address

904 LIATRIS LOOP
ST JOHNS FL
32259-5264
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-2782
  • Fax:
Mailing address:
  • Phone: 386-212-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1021251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: