MEDICARE: MISTY MICHELLE DESOMMA A.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	ARNP9179099	FL

General Provider Information

NPI Number	:	1215995329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY MICHELLE DESOMMA A.R.N.P.

Provider Business Mailing Address
First Line	:	12778 VISTA PINE CIR
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33913-7973
Country	:	US
Telephone Number	:	239-768-3252
Fax Number	:

Provider Business Practice Location Address
First Line	:	15641 NEW HAMPSHIRE CT
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33908-4123
Country	:	US
Telephone Number	:	239-275-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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