Provider Demographics
NPI:1326205337
Name:MILLER, CHRISTINE ELIZABETH (MS, RD, LD/N, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, RD, LD/N, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9512 CAVENDISH DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5151
Mailing Address - Country:US
Mailing Address - Phone:813-340-3084
Mailing Address - Fax:813-354-3362
Practice Address - Street 1:9512 CAVENDISH DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5151
Practice Address - Country:US
Practice Address - Phone:813-340-3084
Practice Address - Fax:813-354-3362
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 2220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered