Provider Demographics
NPI:1336650142
Name:MILLER, ERICA M (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAIR LOSS SPECIALIST
Mailing Address - Street 1:35048 DEERFIELD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1995
Mailing Address - Country:US
Mailing Address - Phone:803-261-3555
Mailing Address - Fax:
Practice Address - Street 1:35048 DEERFIELD OAKS DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1995
Practice Address - Country:US
Practice Address - Phone:803-261-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL11966901744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management