Provider Demographics
NPI:1013552199
Name:MILLER, JUSTIN LEE (CCNS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NE 1ST AVE APT H2201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 NW 10TH AVE UNIT T215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1018
Practice Address - Country:US
Practice Address - Phone:808-294-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2166722163WC0200X
MN524364SA2200X
FLAPRN11004781364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health