Provider Demographics
NPI:1003388083
Name:MILLIS, ANNIE TAYLOR (FNP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:TAYLOR
Last Name:MILLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7532
Mailing Address - Country:US
Mailing Address - Phone:843-992-4619
Mailing Address - Fax:
Practice Address - Street 1:15420 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7532
Practice Address - Country:US
Practice Address - Phone:843-992-4619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12180445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine