Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | ME94134 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME94134 | FL |
NPI | 1134156813 |
---|---|
Provider Name | Andrea Lee Miller |
First Address | Temple Terrace, FL 33637-0904 |
Second Address | Temple Terrace, FL 33637-0904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 03/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275306500 | (05) | FL |
76094 | BCBS (01) | FL |
BM7677581 | DEA (01) | |
E55453 | (02) | |
ME94134 | MD LICENSE (01) | FL |
P02212301 | RAILROAD MEDICARE (01) | FL |