Provider Demographics
NPI:1619387966
Name:MCMILLIAN, COURTNEY ANDONIA (CNM)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANDONIA
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-416-0103
Mailing Address - Fax:561-416-9896
Practice Address - Street 1:3225 AVIATION AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4741
Practice Address - Country:US
Practice Address - Phone:561-416-0103
Practice Address - Fax:561-416-9896
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9234857363LX0001X
FL542129332363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9234857OtherARNP