Healthcare Provider Details

I. General information

NPI: 1598223984
Provider Name (Legal Business Name): MISSY GRAY DISHMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 SIERRA MEADOWS BLVD # 2
NAPLES FL
34113-7328
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 239-732-3140
  • Fax: 855-787-8929
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11045702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: