Provider Demographics
NPI:1609960459
Name:MILES, JENNIFER L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:MILES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 ONE HEALING PL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4600
Mailing Address - Country:US
Mailing Address - Phone:850-431-5360
Mailing Address - Fax:850-431-5367
Practice Address - Street 1:1775 ONE HEALING PL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4600
Practice Address - Country:US
Practice Address - Phone:850-431-5360
Practice Address - Fax:850-431-5367
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2751132363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00282701OtherRAILROAD MEDICARE
FL306425500Medicaid
FLY057VOtherBCBS
FL306425500Medicaid
FLY057VOtherBCBS