MEDICARE: EARL NORMAN MILLER III PA-C

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	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant	PA9100657	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	Y03P5	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962474890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL NORMAN MILLER III PA-C

Provider Business Mailing Address
First Line	:	6800 SOUTHPOINT PKWY STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8203
Country	:	US
Telephone Number	:	904-634-0640
Fax Number	:	904-634-0203

Provider Business Practice Location Address
First Line	:	10475 CENTURION PKWY N STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-5004
Country	:	US
Telephone Number	:	904-634-0640
Fax Number	:	904-634-0203

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

Provider Enumeration Date	:	02/04/2006
Last Update Date	:	07/28/2025

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