Active NPI
Tabitha C. Miller, PAC
- Physician Assistant
- Jacksonville, FL
National Provider Identifier
1760788970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9108064
- Practice address
- 1 Shircliff Way
Jacksonville, FL 32204-4748 - Phone
- (904) 308-7300
- NPI assigned
- Feb 4, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1096273 | NV | |
| Physician Assistant | 363A00000X | PA9108064 | FL | Primary |
Addresses
Primary practice location
1 Shircliff Way
Jacksonville, FL 32204-4748
Mailing address
PO Box 863026
Orlando, FL 32886-3026
Phone (800) 288-8325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1096273 | NV | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Medicine Physicians of Clark Pediatrics McCourt, PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Henderson, NV
- NPI 1568763589
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424044800000",
"number": "1760788970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 863026",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328863026",
"telephone_number": "800-288-8325",
"fax_number": "419-866-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 SHIRCLIFF WAY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322044748",
"telephone_number": "904-308-7300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "TABITHA",
"middle_name": "C.",
"name_prefix": "Mrs.",
"credential": "PAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-04",
"last_updated": "2015-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NV",
"license": "1096273",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9108064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.