Provider Demographics
NPI:1215222898
Name:BORGESTAD, MISTI LEE (FNP, CNM)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:LEE
Last Name:BORGESTAD
Suffix:
Gender:
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4821
Mailing Address - Country:US
Mailing Address - Phone:843-737-5206
Mailing Address - Fax:843-795-7171
Practice Address - Street 1:3423 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4821
Practice Address - Country:US
Practice Address - Phone:843-737-5206
Practice Address - Fax:843-795-7171
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27660363LF0000X
IAA-126661363LF0000X
CA236175367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215222898Medicaid
IA719260001Medicare PIN