Provider Demographics
NPI:1558886820
Name:MILLER, HANNAH NICOLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 BARTRAM PARK BLVD UNIT 1218
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5297
Mailing Address - Country:US
Mailing Address - Phone:850-776-3885
Mailing Address - Fax:
Practice Address - Street 1:12421 SAN JOSE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8662
Practice Address - Country:US
Practice Address - Phone:904-292-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL46772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer