Provider Demographics
NPI:1568583664
Name:DISSIS, ADRIENNE M
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:DISSIS
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 1:7775 134TH ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3740
Mailing Address - Country:US
Mailing Address - Phone:772-581-9972
Mailing Address - Fax:772-589-9241
Practice Address - Street 1:7775 134TH ST
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3740
Practice Address - Country:US
Practice Address - Phone:772-581-9972
Practice Address - Fax:772-589-9241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X-CASE MANA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator