Provider Demographics
NPI:1518147537
Name:MILLER, CAROL DENISE (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DENISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:D
Other - Last Name:FULFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 FIRST COLONIAL RD FL 1
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:757-395-6116
Mailing Address - Fax:757-395-6291
Practice Address - Street 1:1060 FIRST COLONIAL RD FL 1
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-6116
Practice Address - Fax:757-395-6291
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily