Provider Demographics
NPI:1639224793
Name:CORRELL-MILLER, ROSLYN KAREN (NP)
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:KAREN
Last Name:CORRELL-MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14527 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-3102
Mailing Address - Country:US
Mailing Address - Phone:352-521-1474
Mailing Address - Fax:352-521-0212
Practice Address - Street 1:14527 7TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3102
Practice Address - Country:US
Practice Address - Phone:352-521-1474
Practice Address - Fax:352-521-0212
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1925732363LP0808X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761821200Medicaid
FL761821200Medicaid