Provider Demographics
NPI:1033537881
Name:MILLER, BREANA BERRY (MD)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:BERRY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BREANA
Other - Middle Name:LEIGH
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M/D/
Mailing Address - Street 1:417 E CALL ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3401
Mailing Address - Country:US
Mailing Address - Phone:904-368-0368
Mailing Address - Fax:
Practice Address - Street 1:417 E CALL ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3401
Practice Address - Country:US
Practice Address - Phone:904-368-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-2143208000000X
FL150413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty