Provider Demographics
NPI:1366425100
Name:MILLER, NEDRA JOLYN (A-APRN)
Entity type:Individual
Prefix:MS
First Name:NEDRA
Middle Name:JOLYN
Last Name:MILLER
Suffix:
Gender:F
Credentials:A-APRN
Other - Prefix:MS
Other - First Name:NEDRA
Other - Middle Name:JOLYN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:A-APRN, FNP, CNM
Mailing Address - Street 1:5341 GRAND BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4004
Mailing Address - Country:US
Mailing Address - Phone:727-478-0648
Mailing Address - Fax:727-478-0618
Practice Address - Street 1:111 N ORANGE AVE STE 800
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2381
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2750622367A00000X, 207QA0401X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY1129OtherBCBS
FL103394200Medicaid
FLY1129OtherBC & BS OF FLORIDA