Provider Demographics
NPI:1467451062
Name:MILLER, JACQUELINE HELLER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:HELLER
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 CITRUS TOWER BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1947
Mailing Address - Country:US
Mailing Address - Phone:352-241-7050
Mailing Address - Fax:352-241-7035
Practice Address - Street 1:1099 CITRUS TOWER BLVD
Practice Address - Street 2:STE 120
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1947
Practice Address - Country:US
Practice Address - Phone:352-241-7050
Practice Address - Fax:352-241-7035
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102182363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
U0523ZMedicare ID - Type Unspecified
FLP86506Medicare UPIN