MEDICARE: MRS. SARAH MILLER PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11019268	FL

General Provider Information

NPI Number	:	1336786714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH MILLER PMHNP

Provider Business Mailing Address
First Line	:	1815 HEALTH CARE DR STE B
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-5377
Country	:	US
Telephone Number	:	727-358-9911
Fax Number	:	727-499-2612

Provider Business Practice Location Address
First Line	:	1815 HEALTH CARE DR STE B
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-5377
Country	:	US
Telephone Number	:	727-358-9911
Fax Number	:	727-499-2612

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

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	11/18/2024

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