Provider Demographics
NPI:1578932174
Name:MILLAN, BRITTA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTA
Middle Name:
Last Name:MILLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITTA
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3012
Mailing Address - Country:US
Mailing Address - Phone:315-256-8852
Mailing Address - Fax:
Practice Address - Street 1:457 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-894-7500
Practice Address - Fax:732-840-7500
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00375700363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical