Provider Demographics
NPI:1639706674
Name:MILLER, BARBARA SUE (RN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7612
Mailing Address - Country:US
Mailing Address - Phone:386-852-6427
Mailing Address - Fax:386-677-1974
Practice Address - Street 1:671 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7612
Practice Address - Country:US
Practice Address - Phone:386-852-6427
Practice Address - Fax:386-677-1974
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1999422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN1999422OtherFLORIDA DEPT OF HEALTH