MEDICARE: KELLI NIRA MILLER 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1164158986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI NIRA MILLER RN

Provider Business Mailing Address
First Line	:	10303 RIVERBURN DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3164
Country	:	US
Telephone Number	:	813-952-8701
Fax Number	:

Provider Business Practice Location Address
First Line	:	10303 RIVERBURN DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3164
Country	:	US
Telephone Number	:	813-952-8701
Fax Number	:

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

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	07/25/2022

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