Provider Demographics
NPI:1558709386
Name:MILLER, VENECIA ESTELA (RN)
Entity Type:Individual
Prefix:
First Name:VENECIA
Middle Name:ESTELA
Last Name:MILLER
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 1:308 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1500
Mailing Address - Country:US
Mailing Address - Phone:863-537-0848
Mailing Address - Fax:321-733-7970
Practice Address - Street 1:308 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1500
Practice Address - Country:US
Practice Address - Phone:863-537-0848
Practice Address - Fax:321-733-7970
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9175866163W00000X, 372600000X, 3747A0650X, 376J00000X
FLRN 9175866163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker