MEDICARE: MS. CAROLE BETH MILLER R.D.L.D.

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	133V00000X	Registered Dietitian	ND3201	FL

General Provider Information

NPI Number	:	1356631261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLE BETH MILLER R.D.L.D.

Provider Business Mailing Address
First Line	:	1512 VALLEY FORGE BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5339
Country	:	US
Telephone Number	:	813-642-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 VALLEY FORGE BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5339
Country	:	US
Telephone Number	:	813-642-0511
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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