MEDICARE: MISS SANDRA JOY MILLARD RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP 2030392	FL

General Provider Information

NPI Number	:	1013219856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDRA JOY MILLARD RN

Provider Business Mailing Address
First Line	:	3800 CITIBANK CTR
Second Line	:	BUILDING C 1ST FLOOR
City	:	TAMPA
State	:	FL
Zip	:	33610-9559
Country	:	US
Telephone Number	:	813-604-4333
Fax Number	:	813-604-4337

Provider Business Practice Location Address
First Line	:	3800 CITIBANK CTR
Second Line	:	BUILDING C 1ST FLOOR
City	:	TAMPA
State	:	FL
Zip	:	33610-9559
Country	:	US
Telephone Number	:	813-604-4333
Fax Number	:	813-604-4337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	11/30/2010

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