Provider Demographics
NPI:1669126488
Name:YOUR FAVORITE NP CONSULTANT
Entity type:Organization
Organization Name:YOUR FAVORITE NP CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVIDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:863-268-6180
Mailing Address - Street 1:1651 MARSHALL RD SW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1955
Mailing Address - Country:US
Mailing Address - Phone:863-268-6180
Mailing Address - Fax:
Practice Address - Street 1:757 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4712
Practice Address - Country:US
Practice Address - Phone:863-268-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251K00000XAgenciesPublic Health or Welfare
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No305S00000XManaged Care OrganizationsPoint of Service