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NPI Code Detail

MEDICARE: SHELLY MILLER TAT ACNP, MHA

MEDICARE:   SHELLY MILLER TAT  ACNP, MHA
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
1363LA2100XAcute Care Nurse PractitionerRN133463AZ
2363LA2100XAcute Care Nurse Practitioner11304CA

General Provider Information

NPI Number : 1689667636
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY MILLER TAT ACNP, MHA
Provider Business Mailing Address
First Line : 7755 CENTER AVE STE 630
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-204-3953
Fax Number : 844-698-7227
Provider Business Practice Location Address
First Line : 7755 CENTER AVE STE 630
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-204-3953
Fax Number : 844-698-7227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 03/17/2018

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