Individual provider Active NPI

Kristina L Miller, APRN

  • Adult Health Nurse Practitioner
  • Longwood, FL
National Provider Identifier
1720826431
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11033995 Issued in FL
Practice address
555 W Sr 434
Longwood, FL 32750-5119
Phone
(407) 262-2220
Fax
(407) 834-5011
NPI assigned
Jul 17, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X APRN11033995 FL Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 11033995 FL

Addresses

Primary practice location

555 W Sr 434
Longwood, FL 32750-5119

Mailing address

555 W Sr 434
Longwood, FL 32750-5119
Phone (407) 262-2220

Other practice location 1

4979 Washington Ave
Orlando, FL 32819-3258
Phone (407) 625-3060

Other identifiers 1

IdentifierTypeStateIssuer
123771600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240830001969 FL Practitioner - Nurse Practitioner 0446799654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

555 W State Rd
Suite 434
Longwood, FL 32750-5119
Phone (407) 237-6377

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11033995FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2024 Accepting new patients

Locations

555 W State Road 434
Longwood, FL 32750
Phone (407) 767-1200

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1720826431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W SR 434",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505119",
            "telephone_number": "407-262-2220",
            "fax_number": "407-834-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W SR 434",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505119",
            "telephone_number": "407-262-2220",
            "fax_number": "407-834-5011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4979 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328193258",
            "country_code": "US",
            "telephone_number": "407-625-3060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KRISTINA",
        "middle_name": "L",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11033995",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11033995",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123771600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longwood, FL

Sources for this page

Verify at the official NPI Registry.