Provider Demographics
NPI:1841473246
Name:MILLER, AMY (CNA)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LINCOLN AVE
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-3297
Mailing Address - Country:US
Mailing Address - Phone:321-783-6098
Mailing Address - Fax:
Practice Address - Street 1:212 LINCOLN AVE
Practice Address - Street 2:SUITE # 3
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-3297
Practice Address - Country:US
Practice Address - Phone:321-783-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA94456376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide