Provider Demographics
NPI:1104318401
Name:MILLS, ACACIA (CNA)
Entity type:Individual
Prefix:
First Name:ACACIA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SAND PINE TRL
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1253
Mailing Address - Country:US
Mailing Address - Phone:850-933-8929
Mailing Address - Fax:
Practice Address - Street 1:15715 S DIXIE HWY STE 328
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1883
Practice Address - Country:US
Practice Address - Phone:786-592-1415
Practice Address - Fax:253-270-8779
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA347186376K00000X, 374U00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide