Provider Demographics
NPI:1659997047
Name:ISSA, PRISSILLA (OD)
Entity type:Individual
Prefix:
First Name:PRISSILLA
Middle Name:
Last Name:ISSA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6111
Mailing Address - Country:US
Mailing Address - Phone:239-325-2015
Mailing Address - Fax:239-325-2014
Practice Address - Street 1:9441 CORKSCREW PALMS CIRCLE
Practice Address - Street 2:STE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:33928-6275
Practice Address - Country:US
Practice Address - Phone:239-325-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC5889OtherFL MEDICAL LICENSE