Provider Demographics
NPI:1164763546
Name:MILLER, JENNIFER MARGARET (MS, RD, LD/N)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARGARET
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MARGARET
Other - Last Name:ASMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-6032
Mailing Address - Country:US
Mailing Address - Phone:904-349-1449
Mailing Address - Fax:
Practice Address - Street 1:1311 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-6032
Practice Address - Country:US
Practice Address - Phone:904-349-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered