Provider Demographics
NPI:1104615434
Name:MILLAR, JOSE CARLOS (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:MILLAR
Suffix:
Gender:
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12166 STONE PINE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5595
Mailing Address - Country:US
Mailing Address - Phone:813-562-4628
Mailing Address - Fax:
Practice Address - Street 1:12166 STONE PINE ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5595
Practice Address - Country:US
Practice Address - Phone:813-562-4628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily