Provider Demographics
NPI:1689979486
Name:MILLER, JACQUELINE NICHOLE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:NICHOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:NICHOLE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:237 W SCHROCK RD STE B
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2874
Mailing Address - Country:US
Mailing Address - Phone:614-891-0005
Mailing Address - Fax:614-890-3614
Practice Address - Street 1:237 W SCHROCK RD STE B
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2874
Practice Address - Country:US
Practice Address - Phone:614-891-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN285048163WC0200X, 163WE0003X
OHAPRN.CNP.021436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency