Provider Demographics
NPI:1891049375
Name:MILLER, MELISSA DYANN (AA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DYANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BEACON SOUND WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3372
Mailing Address - Country:US
Mailing Address - Phone:423-580-4787
Mailing Address - Fax:
Practice Address - Street 1:4805 W LAUREL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4552
Practice Address - Country:US
Practice Address - Phone:727-230-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA147367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant