Provider Demographics
NPI:1609649193
Name:MCMILLER, JACQUELINE SAMANTHA (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SAMANTHA
Last Name:MCMILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 RICH BEEM STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4333
Mailing Address - Country:US
Mailing Address - Phone:915-504-6900
Mailing Address - Fax:833-606-0514
Practice Address - Street 1:3570 RICH BEEM STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4333
Practice Address - Country:US
Practice Address - Phone:915-504-6900
Practice Address - Fax:833-606-0514
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty