Provider Demographics
NPI:1265085047
Name:MILLAN, MADONNA (APRN)
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:
Last Name:MILLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MADONNA
Other - Middle Name:
Other - Last Name:MILLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14626 SW 98 TERR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:786-575-2695
Mailing Address - Fax:
Practice Address - Street 1:CLINICAL RESEARCH BUILDING
Practice Address - Street 2:1120 NW 14 STREET 4TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9364696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty