Individual
MRS. JESSIE VANDERVEER MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(407) 975-0412
Mailing address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(407) 975-0412
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9105829
FL
363AM0700X
Medical Physician Assistant
1977
GA
363AM0700X
Medical Physician Assistant
Primary
PA9105829
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ET296Z
—
FL
Enumeration date
11/17/2009
Last updated
01/10/2023
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