Provider Demographics
NPI:1427031228
Name:MCMILLIN, JOHN M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:MCMILLIN
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:MEDICAL CENTER CLINIC ANESTHESIA
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8147
Mailing Address - Fax:850-969-2148
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:WEST FLORIDA MEDICAL CENTER CLINIC PA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8688
Practice Address - Fax:850-969-2958
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2014-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3160362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302111400Medicaid
FLG2261OtherBSFL
FLY6369Medicare ID - Type Unspecified