Provider Demographics
NPI:1740870625
Name:MILLER, MARINA D (HAS,BC-HIS)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:HAS,BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 N YOUNG BLVD
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-9181
Mailing Address - Country:US
Mailing Address - Phone:229-395-3494
Mailing Address - Fax:352-493-2312
Practice Address - Street 1:2471 N YOUNG BLVD
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-9181
Practice Address - Country:US
Practice Address - Phone:352-493-2390
Practice Address - Fax:352-493-2312
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4570237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist