Provider Demographics
NPI:1114137411
Name:MILLER, MARYANN ELIZABETH (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 20TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3513
Mailing Address - Country:US
Mailing Address - Phone:727-550-0852
Mailing Address - Fax:727-550-0852
Practice Address - Street 1:256 20TH AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3513
Practice Address - Country:US
Practice Address - Phone:727-550-0852
Practice Address - Fax:727-550-0852
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered