Provider Demographics
NPI:1134461197
Name:MILLER, NICOLE MARY (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARY
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARY
Other - Last Name:JAMBETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 151637
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-1637
Mailing Address - Country:US
Mailing Address - Phone:813-870-1995
Mailing Address - Fax:
Practice Address - Street 1:4714 N ARMENIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2603
Practice Address - Country:US
Practice Address - Phone:813-870-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9268975363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics