Provider Demographics
NPI:1033462791
Name:RESETAR, MILLEDA (AP, LAC, DOM)
Entity Type:Individual
Prefix:MRS
First Name:MILLEDA
Middle Name:
Last Name:RESETAR
Suffix:
Gender:F
Credentials:AP, LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CITRUS TOWER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 CITRUS TOWER BLVD
Practice Address - Street 2:STE A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6503
Practice Address - Country:US
Practice Address - Phone:352-577-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist