Provider Demographics
NPI:1144734385
Name:MCMILLON-THOMAS, CONNIE DELORISE (RN)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:DELORISE
Last Name:MCMILLON-THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 PEACH TREE LN
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-2841
Mailing Address - Country:US
Mailing Address - Phone:407-739-0816
Mailing Address - Fax:
Practice Address - Street 1:519 PEACH TREE LN
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-2841
Practice Address - Country:US
Practice Address - Phone:407-739-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1757422163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice