Provider Demographics
NPI:1154338424
Name:MILEY, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7747
Mailing Address - Country:US
Mailing Address - Phone:850-479-4791
Mailing Address - Fax:850-494-2260
Practice Address - Street 1:161 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-3140
Practice Address - Country:US
Practice Address - Phone:850-696-4000
Practice Address - Fax:850-494-2260
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2621487-00Medicaid
FL03233ZMedicare ID - Type Unspecified
FL2621487-00Medicaid