Provider Demographics
NPI:1346510492
Name:MILLER-OWEN, COLLEEN (APN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MILLER-OWEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-660-6400
Mailing Address - Fax:
Practice Address - Street 1:10740 PALM RIVER RD STE 360
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4578
Practice Address - Country:US
Practice Address - Phone:813-660-6400
Practice Address - Fax:813-660-6699
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003729363L00000X, 363LF0000X
FLAPRN11002336363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILCA4748OtherRAILROAD MEDICARE PTAN (GROUP)
IL206147094OtherMEDICARE PTAN (INDIVIDUAL)
ILP01090231OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)
ILP01090231OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)