Antionette Jarshawn Miller-Maultsby

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

103TH0100X Issued in FL

Practice address

4401 Will Scarlet Rd
Jacksonville, FL 32208-1154

Phone

(904) 352-0066

NPI assigned

May 15, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Heart to Heart Connection Companion Service

  • In Home Supportive Care Agency
  • Jacksonville, FL
  • NPI 1487419305
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1013573039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 WILL SCARLET RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322081154",
            "telephone_number": "904-352-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 WILL SCARLET RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322081154",
            "telephone_number": "904-352-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER-MAULTSBY",
        "first_name": "ANTIONETTE",
        "middle_name": "JARSHAWN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-15",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "FL",
            "license": "103TH0100X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Millennium Physician Group LLC
• Millennium Physician Group LLC
• Millennium Physician Group LLC
• Millennium Physician Group LLC
• Millennium Physician Group LLC
• Mary Eileen Miller-Mazza, CRNA
• Abigail Christine Miller, MSN, APRN, FNP-C
• Alan B Miller, M.D.
• Alicia Miller, QASP
• Alison Marie Miller, APRN

• Health Service Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Health Service Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.