Provider Demographics
NPI:1770477291
Name:DISLA, AMY (APRN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DISLA
Suffix:
Gender:F
Credentials:APRN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 SW 154TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2649
Mailing Address - Country:US
Mailing Address - Phone:954-639-6693
Mailing Address - Fax:
Practice Address - Street 1:14591 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8038
Practice Address - Country:US
Practice Address - Phone:954-639-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9482194163WE0003X
FLAPRN11039703363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency