Provider Demographics
NPI:1629354899
Name:MILLER, MARSHA PATRICE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:PATRICE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-0305
Mailing Address - Country:US
Mailing Address - Phone:904-234-1982
Mailing Address - Fax:
Practice Address - Street 1:1583 WEST 18TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-4866
Practice Address - Country:US
Practice Address - Phone:904-888-1493
Practice Address - Fax:904-354-0830
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1316831164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689294900Medicaid
FL685158496Medicaid