Provider Demographics
NPI:1417049719
Name:MILLER, JILL (MD PHD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3116
Mailing Address - Country:US
Mailing Address - Phone:321-984-9400
Mailing Address - Fax:321-984-0150
Practice Address - Street 1:1333 PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3116
Practice Address - Country:US
Practice Address - Phone:321-984-9400
Practice Address - Fax:321-984-0150
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0006433000Medicaid
FLBH960YMedicare PIN
FLII2883Medicare UPIN