Healthcare Provider Details

I. General information

NPI: 1346223229
Provider Name (Legal Business Name): CATHY L CRISS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19531 COCHRAN BLVD
PORT CHARLOTTE FL
33948-2081
US

IV. Provider business mailing address

3434 HANCOCK BRIDGE PKWY
N FT MYERS FL
33903-7094
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-3535
  • Fax: 941-766-7999
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0007162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: