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General NPI Number Information
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NPI Number | 1265801880
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Entity Type | Individual
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Provider Name | NICOLE LYNN MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 3890 TAMPA RD STE 202
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City | PALM HARBOR
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State | FL
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Zip | 34684
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Country | US
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Telephone | 727-778-7557
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Fax |
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Provider Business Mailing Address
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Address Line | 3523 TABERNACLE PL
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City | TAMPA
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State | FL
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Zip | 33607-5834
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Country | US
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Telephone | 813-391-5389
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9109082
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License Number State | FL
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