Provider Demographics
NPI:1750483251
Name:AMELY, MILSA (RNFA)
Entity type:Individual
Prefix:
First Name:MILSA
Middle Name:
Last Name:AMELY
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 SW HUNTERS CLUB WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2029
Mailing Address - Country:US
Mailing Address - Phone:772-219-0598
Mailing Address - Fax:772-335-2422
Practice Address - Street 1:2306 SW HUNTERS CLUB WAY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2029
Practice Address - Country:US
Practice Address - Phone:772-219-0598
Practice Address - Fax:772-335-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1547582163WX0003X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3100683700Medicaid