Provider Demographics
NPI:1366976540
Name:MILLER, ANNA PATRICE
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:PATRICE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110454
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32911-0454
Mailing Address - Country:US
Mailing Address - Phone:407-668-3594
Mailing Address - Fax:
Practice Address - Street 1:1439 HEARTWELLVILLE ST NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7060
Practice Address - Country:US
Practice Address - Phone:407-668-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47-5027053OtherEIN NUMBER