Provider Demographics
NPI:1871990978
Name:MCMILLAN, LISA
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 REDFIN DR
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4709
Mailing Address - Country:US
Mailing Address - Phone:407-873-3662
Mailing Address - Fax:863-496-7260
Practice Address - Street 1:1661 REDFIN DR
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-4709
Practice Address - Country:US
Practice Address - Phone:407-873-3662
Practice Address - Fax:863-496-7260
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9218748163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12559OtherASSISTED LIVING FACILITY