Provider Demographics
NPI:1649396391
Name:MILLER, KATHRYN C (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIAL DEPARTMENT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:600 N CATTLEMEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6422
Practice Address - Country:US
Practice Address - Phone:941-377-9993
Practice Address - Fax:941-343-0026
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1098312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305627900Medicaid
FLU1103UMedicare PIN
FL305627900Medicaid