Provider Demographics
NPI:1689325136
Name:MCMILLIAN, ANNA DE LA SELVA (SFA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:DE LA SELVA
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:SFA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 N FEDERAL HWY APT 221
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6669
Mailing Address - Country:US
Mailing Address - Phone:210-685-7023
Mailing Address - Fax:
Practice Address - Street 1:4611 N FEDERAL HWY APT 221
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6669
Practice Address - Country:US
Practice Address - Phone:210-685-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM254-044-66-926-0OtherDRIVERS LICENSE
532403307OtherPASSPORT