Individual
MS. TI'ARRA DOMINIQUE LEE MCMILLIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2212 E HENRY AVE, TAMPA, FL 33610-4433
(813) 239-8069
Mailing address
5038 TEMPLE HEIGHTS RD APT 30, TAMPA, FL 33617-4626
(813) 451-5605
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5226312
FL
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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