Provider Demographics
NPI:1023214970
Name:MILLER, MARTINE JULES (LPN)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:JULES
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARTINE
Other - Middle Name:JULES
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:20260 NE 3RD CT APT 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5216
Mailing Address - Country:US
Mailing Address - Phone:754-368-4921
Mailing Address - Fax:305-676-9040
Practice Address - Street 1:3600 S STATE ROAD 7 STE 330
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5290
Practice Address - Country:US
Practice Address - Phone:754-244-5808
Practice Address - Fax:305-676-9040
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2353783747P1801X
FLPN941521164W00000X
372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001866900Medicaid
FL001866900Medicaid
FL003059300Medicaid