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MILLENNIUM PHYSICIAN GROUP LLC
NPI 1700558574
Family Medicine in Fernandina Beach, FL

Active since September 30, 2021CLIA Certified · 4 labs
1340 S 18TH ST STE 204, FERNANDINA BEACH, FL 32034(904) 261-0643(941) 277-4082 Get Directions Write a Review

NPPES record last updated: January 19, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 19, 2023, Sep 30, 2021 (2 updates tracked since 2021).

About Millennium Physician Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MILLENNIUM PHYSICIAN GROUP LLC (NPI 1700558574) is a healthcare organization registered as a family medicine in Fernandina Beach, Florida and active in the NPI registry since September 2021. The organization holds 4 active CLIA laboratory certificates and lists Mary Haltigan, Director Of Revenue Cycle, as its authorized official.

NPPES Registry Identity

NPI1700558574
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMILLENNIUM PHYSICIAN GROUP LLC
Location Address1340 S 18TH ST STE 204Fernandina Beach, FL 32034-4733
Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342 · (877) 856-3774 · Fax (239) 599-2612
Phone(904) 261-0643
Fax(941) 277-4082
Organization SubpartNo
Authorized OfficialMary HaltiganDirector Of Revenue Cycle · (877) 856-3774
Enumeration DateSeptember 30, 2021
Last NPPES UpdateJanuary 19, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2023
✔ NPI 1700558574 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1340 S 18TH ST STE 204, Fernandina Beach, FL 32034
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA 5

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2338755

Millennium Physician Group, LLC · Fernandina Beach, FL
Active · expires Feb 17, 2028
CLIA Number10D2338755
Laboratory TypePhysician Office
Certificate Effective DateFebruary 18, 2026
Certificate Expiration DateFebruary 17, 2028
Laboratory DirectorJeffry Misko
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group, LLC1126 S 14th St, Fernandina Beach, FL 32034
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 10D0974052

Millennium Physician Group, LLC · Fernandina Beach, FL
Active · expires Dec 6, 2027
CLIA Number10D0974052
Laboratory TypePhysician Office
Certificate Effective DateDecember 7, 2025
Certificate Expiration DateDecember 6, 2027
Laboratory DirectorGerald B. Burford
Laboratory Phone(904) 277-4690
Laboratory LocationMillennium Physician Group, LLC1132 S 14th St, Fernandina Beach, FL 32034
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 10D2229364

Millennium Physician Group, LLC · Fernandina Beach, FL
Active · expires Jul 11, 2027
CLIA Number10D2229364
Laboratory TypePhysician Office
Certificate Effective DateJuly 12, 2025
Certificate Expiration DateJuly 11, 2027
Laboratory DirectorKedra Williams
Laboratory Phone(904) 648-8081
Laboratory LocationMillennium Physician Group, LLC22439 Flora Parke Crossing, Fernandina Beach, FL 32034
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0645048

Millennium Physician Group, LLC · Fernandina Beach, FL
Active · expires Mar 1, 2027
CLIA Number10D0645048
Laboratory TypePhysician Office
Certificate Effective DateMarch 2, 2025
Certificate Expiration DateMarch 1, 2027
Laboratory DirectorAlex Llarena
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group, LLC1411 South 14th St Ste B, Fernandina Beach, FL 32034
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2309376

Millennium Physician Group LLC · Fernandina Beach, FL
Expired · Aug 13, 2026
CLIA Number10D2309376
Laboratory TypePhysician Office
Certificate Effective DateAugust 14, 2024
Certificate Expiration DateAugust 13, 2026
Laboratory DirectorGerald B. Burford
Laboratory Phone(904) 420-6105
Laboratory LocationMillennium Physician Group LLC1128 South 14th Street, Fernandina Beach, FL 32034
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. SHARON ANN BURKE ARNP
Nurse Practitioner (Family)
1340 S 18TH ST STE 204
FERNANDINA BEACH, FL 32034
Nassau County (904) 261-0643
BLAKE THOMPSON
Internal Medicine (Gastroenterology)
1340 S 18TH ST STE 204
FERNANDINA BEACH, FL 32034
Nassau County (904) 398-7205
MARY BARBARA MD
Internal Medicine (Gastroenterology)
1340 S 18TH ST STE 204
FERNANDINA BEACH, FL 32034
Nassau County (904) 398-7205

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Millennium Physician Group LLC's NPI number?

The NPI number for Millennium Physician Group LLC is 1700558574. It was assigned to this organization in the NPPES registry on September 30, 2021.

Where is Millennium Physician Group LLC located?

Millennium Physician Group LLC is located at 1340 S 18th St Ste 204, Fernandina Beach, FL 32034. The listed phone number is (904) 261-0643.

What is Millennium Physician Group LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Millennium Physician Group LLC hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Millennium Physician Group LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Millennium Physician Group LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Millennium Physician Group LLC was last updated on January 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.