Provider Demographics
NPI:1427359645
Name:MCMILLAN, DOUGLAS S (CRNA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:CRNA
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 848558
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8558
Mailing Address - Country:US
Mailing Address - Phone:352-237-0509
Mailing Address - Fax:352-237-9808
Practice Address - Street 1:3309 SW 34TH CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3392
Practice Address - Country:US
Practice Address - Phone:352-237-0509
Practice Address - Fax:352-237-9808
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9323545367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003552100Medicaid
FLP01030746OtherRAILROAD MEDICARE
FLG00PXOtherBCBS OF FL
FLEY390ZMedicare PIN