Provider Demographics
NPI:1215572623
Name:ADLER, MISTY LILLIAN
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LILLIAN
Last Name:ADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2469 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1702
Mailing Address - Country:US
Mailing Address - Phone:727-467-9622
Mailing Address - Fax:
Practice Address - Street 1:2469 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1702
Practice Address - Country:US
Practice Address - Phone:727-467-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator