Provider Demographics
NPI:1194837955
Name:ADVANCED PRACTICE MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ADVANCED PRACTICE MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:CLARA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:386-749-0750
Mailing Address - Street 1:1301 BLACK BEAR RANCH TR
Mailing Address - Street 2:
Mailing Address - City:PIERSON
Mailing Address - State:FL
Mailing Address - Zip Code:32180-2682
Mailing Address - Country:US
Mailing Address - Phone:386-749-0750
Mailing Address - Fax:
Practice Address - Street 1:1301 BLACK BEAR RANCH TR
Practice Address - Street 2:
Practice Address - City:PIERSON
Practice Address - State:FL
Practice Address - Zip Code:32180-2682
Practice Address - Country:US
Practice Address - Phone:386-749-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1258442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID