Provider Demographics
NPI:1508308628
Name:MCMILLAN, SEPRENA (RN)
Entity Type:Individual
Prefix:
First Name:SEPRENA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 PHILLIPS RD APT 3204
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5366
Mailing Address - Country:US
Mailing Address - Phone:850-491-4804
Mailing Address - Fax:
Practice Address - Street 1:2350 PHILLIPS RD APT 3204
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5366
Practice Address - Country:US
Practice Address - Phone:850-491-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5159539164W00000X
FLRN9482726163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse