Provider Demographics
NPI:1679938237
Name:MYSH, NATALIA (APN)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:
Last Name:MYSH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 MCGREGOR RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9658
Mailing Address - Country:US
Mailing Address - Phone:201-317-3386
Mailing Address - Fax:
Practice Address - Street 1:1000 AIRPORT RD S # PULLINGS
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4366
Practice Address - Country:US
Practice Address - Phone:239-307-1800
Practice Address - Fax:239-308-1799
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00589100363LA2200X, 363LG0600X
FL11009168363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology