Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | F12180445 | FL |
NPI | 1003388083 |
---|---|
Provider Name | Annie Taylor Millis |
First Address | Fort Myers, FL 33905-7532 |
Second Address | Fort Myers, FL 33905-7532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2019 |
Last Update Date | 01/01/2019 |