Provider Demographics
NPI:1538800040
Name:MILLER, FREDDIE LEE III (LPN)
Entity type:Individual
Prefix:
First Name:FREDDIE
Middle Name:LEE
Last Name:MILLER
Suffix:III
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12859 BRYNWOOD PRESERVE LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-4802
Mailing Address - Country:US
Mailing Address - Phone:239-276-2412
Mailing Address - Fax:
Practice Address - Street 1:12859 BRYNWOOD PRESERVE LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-4802
Practice Address - Country:US
Practice Address - Phone:239-276-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5228098164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse