Provider Demographics
NPI:1639895691
Name:MILLER, MARK DANIEL (APRN, AGACNP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANIEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:APRN, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 VALERIA ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5014
Mailing Address - Country:US
Mailing Address - Phone:717-460-1625
Mailing Address - Fax:
Practice Address - Street 1:1104 16TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2305
Practice Address - Country:US
Practice Address - Phone:615-455-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000244964163W00000X
TN33688363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse