Provider Demographics
NPI:1841608643
Name:MILTENBERGER, JAMIE JUSTINE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:JUSTINE
Last Name:MILTENBERGER
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:JUSTINE
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1226 DUNDEE LN
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-8301
Mailing Address - Country:US
Mailing Address - Phone:937-572-6559
Mailing Address - Fax:
Practice Address - Street 1:1800 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4642
Practice Address - Country:US
Practice Address - Phone:850-769-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9287023367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9287023OtherARNP LICENSE
FLRN9287023OtherLICENSE
FLARNP9287023OtherARNP LICENSE
VALNP0024174595OtherLNP LICENSE
HIRN-859964OtherRN LICENSE
VARN0001270721OtherRN LICENSE