Provider Demographics
NPI:1700951688
Name:MILLIGAN, JOHN R (PHD, CAP FLORIDA)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:PHD, CAP FLORIDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 CIRCLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5764
Mailing Address - Country:US
Mailing Address - Phone:904-639-5241
Mailing Address - Fax:
Practice Address - Street 1:2841 CIRCLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5764
Practice Address - Country:US
Practice Address - Phone:904-639-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4633103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical