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General NPI Number Information
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NPI Number | 1043940356
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Entity Type | Individual
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Provider Name | JAKAYLA MILLER
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 205 RIDGEWOOD AVE
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City | BRANDON
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State | FL
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Zip | 33510
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Country | US
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Telephone | 813-816-1788
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Fax |
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Provider Business Mailing Address
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Address Line | 4026 APRIL ST. N.
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City | LAKELAND
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State | FL
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Zip | 33812
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Country | US
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Telephone | 813-816-1788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW22002
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C019099
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License Number State | NC
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