Provider Demographics
NPI:1841355146
Name:MILLER, JANICE H (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:H
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 NETTIE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-7843
Mailing Address - Country:US
Mailing Address - Phone:904-733-8918
Mailing Address - Fax:904-731-2922
Practice Address - Street 1:5645 NETTIE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7843
Practice Address - Country:US
Practice Address - Phone:904-733-8918
Practice Address - Fax:904-731-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74412Medicare ID - Type Unspecified