Provider Demographics
NPI:1689636235
Name:MILLIGAN, JAINE E (ARNP)
Entity Type:Individual
Prefix:
First Name:JAINE
Middle Name:E
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 BARKLEY CIR
Mailing Address - Street 2:BUILDING A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7543
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-275-1969
Practice Address - Street 1:12470 TELECOM DR STE 301
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0904
Practice Address - Country:US
Practice Address - Phone:866-204-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9200330363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3071979-00Medicaid
FL3071979-00Medicaid
FLU5372ZMedicare ID - Type Unspecified