Provider Demographics
NPI:1801566013
Name:MILLSAPS, MADISON NICOLE (NP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:MILLSAPS
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 1:240 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35983-3041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 RED HOOK PLZ
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1306
Practice Address - Country:US
Practice Address - Phone:256-706-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-172106163W00000X, 363LA2100X
VI200159363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse