MEDICARE: JAKAYLA MILLER

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	1041C0700X	Clinical Social Worker	SW22002	FL
2	1041C0700X	Clinical Social Worker	C019099	NC

General Provider Information

NPI Number	:	1043940356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKAYLA MILLER

Provider Business Mailing Address
First Line	:	4026 APRIL ST. N.
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812
Country	:	US
Telephone Number	:	813-816-1788
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 RIDGEWOOD AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510
Country	:	US
Telephone Number	:	813-816-1788
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	01/05/2026

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Directions to “ JAKAYLA MILLER ” Practice Location

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