MEDICARE: MELISSA ANN 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1417695503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN MILLER

Provider Business Mailing Address
First Line	:	1419 GULF STREAM CIR APT 202
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-2876
Country	:	US
Telephone Number	:	215-827-7375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 GULF STREAM CIR APT 202
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-2876
Country	:	US
Telephone Number	:	215-827-7375
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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