Provider Demographics
NPI:1124334479
Name:MILLNS, LAURA ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELAINE
Last Name:MILLNS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4531
Mailing Address - Country:US
Mailing Address - Phone:813-884-1626
Mailing Address - Fax:813-886-0589
Practice Address - Street 1:6001 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4531
Practice Address - Country:US
Practice Address - Phone:813-884-1626
Practice Address - Fax:813-886-0589
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105562207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0583Medicare PIN