Provider Demographics
NPI:1194089920
Name:MILLER, ANDREA MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5810
Mailing Address - Country:US
Mailing Address - Phone:912-355-1010
Mailing Address - Fax:912-721-3092
Practice Address - Street 1:4 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5810
Practice Address - Country:US
Practice Address - Phone:912-355-1010
Practice Address - Fax:912-721-3092
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN194038363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2496Medicaid
GA003125590AMedicaid
GAP01076503OtherRAILROAD MEDICARE
GADN4827OtherRAILROAD MEDICARE
GADN4827OtherRAILROAD MEDICARE