Provider Demographics
NPI:1801625348
Name:BLAIN, MILTIYIA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MILTIYIA
Middle Name:
Last Name:BLAIN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 REVEREND NATHANIEL L HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7226
Mailing Address - Country:US
Mailing Address - Phone:321-290-0365
Mailing Address - Fax:
Practice Address - Street 1:6100 MINTON RD NW STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32907-1900
Practice Address - Country:US
Practice Address - Phone:321-724-1171
Practice Address - Fax:321-724-9024
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily