Provider Demographics
NPI:1578343661
Name:MILLIKEN, CAROL LYNN
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 VISTA PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6742
Mailing Address - Country:US
Mailing Address - Phone:561-231-0233
Mailing Address - Fax:
Practice Address - Street 1:2054 VISTA PKWY STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6742
Practice Address - Country:US
Practice Address - Phone:561-913-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029021363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health