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General NPI Number Information
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NPI Number | 1265099238
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Entity Type | Individual
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Provider Name | KANISHA L. MILLER APRN
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Gender | Female
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 201 W PLYMOUTH AVE
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City | DELAND
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State | FL
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Zip | 32720-2753
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Country | US
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Telephone | 407-732-4272
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Fax | 407-732-4579
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Provider Business Mailing Address
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Address Line | 308 RIDGE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32305-7006
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Country | US
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Telephone | 850-443-3057
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP11002017
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License Number State | FL
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