Provider Demographics
NPI:1659821387
Name:MILLS, JEFFREY D (AUD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 NIKKI VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4879
Mailing Address - Country:US
Mailing Address - Phone:813-571-7184
Mailing Address - Fax:813-654-4695
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:STE 211
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-844-4967
Practice Address - Fax:813-889-0847
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2079231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist