Provider Demographics
NPI:1154674778
Name:MILLER, CYNTHIA ROXANNE (PCT)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:ROXANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11520 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3504
Mailing Address - Country:US
Mailing Address - Phone:321-276-2209
Mailing Address - Fax:
Practice Address - Street 1:11520 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3504
Practice Address - Country:US
Practice Address - Phone:321-276-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31001093767374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide