Provider Demographics
NPI:1083968184
Name:MCMILLAN, JAIME LYN (MED)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LYN
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9018 SW 100TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5963
Mailing Address - Country:US
Mailing Address - Phone:352-222-9104
Mailing Address - Fax:
Practice Address - Street 1:9018 SW 100TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-5963
Practice Address - Country:US
Practice Address - Phone:352-222-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist