MEDICARE: MILI MARIA XAVIER FNP

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	363L00000X	Nurse Practitioner	APRN11002643	FL

General Provider Information

NPI Number	:	1851932941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILI MARIA XAVIER FNP

Provider Business Mailing Address
First Line	:	5670 54TH AVE N STE A-1
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-2067
Country	:	US
Telephone Number	:	727-548-0260
Fax Number	:	727-548-0270

Provider Business Practice Location Address
First Line	:	5670 54TH AVE N STE A-1
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-2067
Country	:	US
Telephone Number	:	727-548-0260
Fax Number	:	727-548-0270

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	10/01/2019

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