Provider Demographics
NPI:1023554516
Name:MILLIGAN, ADAM (CRNA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 RENDEZVOUS CV
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4782
Mailing Address - Country:US
Mailing Address - Phone:404-632-2577
Mailing Address - Fax:
Practice Address - Street 1:4720 RENDEZVOUS CV
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4782
Practice Address - Country:US
Practice Address - Phone:404-632-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9381753367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered