Healthcare Provider Details

I. General information

NPI: 1912717414
Provider Name (Legal Business Name): MISTY A ORR REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N US HIGHWAY 17 92 STE 24
LONGWOOD FL
32750-3624
US

IV. Provider business mailing address

1530 HOLLY AVE
MERRITT ISLAND FL
32952-5884
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-6699
  • Fax:
Mailing address:
  • Phone: 321-427-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9416453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: