Provider Demographics
NPI:1063835122
Name:MILLER, DAVIDA NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 MARSHALL RD SW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1955
Mailing Address - Country:US
Mailing Address - Phone:510-650-2351
Mailing Address - Fax:
Practice Address - Street 1:1651 MARSHALL RD SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1955
Practice Address - Country:US
Practice Address - Phone:510-650-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233429372600000X, 376J00000X
FL11009020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker