Provider Demographics
NPI:1669432399
Name:MILLER, SALLY (ARNP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-851-5600
Mailing Address - Fax:407-438-9585
Practice Address - Street 1:11140 W COLONIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3300
Practice Address - Country:US
Practice Address - Phone:407-851-5600
Practice Address - Fax:407-438-9585
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2733512363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4671YMedicare ID - Type Unspecified
FLP15123Medicare UPIN