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General NPI Number Information
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NPI Number | 1609539899
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Entity Type | Individual
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Provider Name | MIRANDA ANN MILLER APRN
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Gender | Female
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 14550 OLD SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2460
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Country | US
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Telephone | 902-271-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 4640 RIDGE WALK LN
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City | JACKSONVILLE
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State | FL
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Zip | 32257-3715
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Country | US
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Telephone | 904-556-1414
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN11011936
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License Number State | FL
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