Healthcare Provider Details

I. General information

NPI: 1083120695
Provider Name (Legal Business Name): JOANNA LYNN MILLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA LYNN DEVRIES PA

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43300 SOUTHERN WALK PLAZA, SUITE 100
BROADLANDS VA
20148-4463
US

IV. Provider business mailing address

258 W MEADOWLAND LN
STERLING VA
20164-1141
US

V. Phone/Fax

Practice location:
  • Phone: 571-252-7353
  • Fax: 571-223-5340
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008295
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: