MEDICARE: MRS. NATALIA MYSH APN

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	363LA2200X	Adult Health Nurse Practitioner	26NJ00589100	NJ
2	363LG0600X	Gerontology Nurse Practitioner	26NJ00589100	NJ
3	363LA2200X	Adult Health Nurse Practitioner	11009168	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679938237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIA MYSH APN

Provider Business Mailing Address
First Line	:	1685 MCGREGOR RESERVE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9658
Country	:	US
Telephone Number	:	201-317-3386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 AIRPORT RD S # PULLINGS
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-4366
Country	:	US
Telephone Number	:	239-307-1800
Fax Number	:	239-308-1799

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

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	03/15/2023

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