Provider Demographics
NPI:1295030898
Name:MILLER, VASHTI G (DNS, ANP-BC)
Entity Type:Individual
Prefix:
First Name:VASHTI
Middle Name:G
Last Name:MILLER
Suffix:
Gender:F
Credentials:DNS, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18550 US HIGHWAY 441
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6751
Mailing Address - Country:US
Mailing Address - Phone:352-735-3755
Mailing Address - Fax:352-735-3151
Practice Address - Street 1:18550 US HIGHWAY 441
Practice Address - Street 2:STE A
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6751
Practice Address - Country:US
Practice Address - Phone:352-735-3755
Practice Address - Fax:352-735-3151
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212631363LA2200X
FLARNP9441202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295030898OtherNPI