Provider Demographics
NPI:1235623380
Name:MILLER, LATRICE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LATRICE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 BRUNSWICK PARK CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2153
Mailing Address - Country:US
Mailing Address - Phone:901-493-3407
Mailing Address - Fax:
Practice Address - Street 1:8760 BRUNSWICK PARK CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2153
Practice Address - Country:US
Practice Address - Phone:901-493-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily