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General NPI Number Information
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NPI Number | 1477371474
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Entity Type | Individual
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Provider Name | MISTY LE ANN SIDES
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Gender | Female
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 501 6TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-8917
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Fax |
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Provider Business Mailing Address
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Address Line | 501 6TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-8917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | APRN11036871
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License Number State | FL
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