Provider Demographics
NPI:1841852266
Name:GADDIS, MISTY V (DNP)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:V
Last Name:GADDIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 SW COHUTTA ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4647
Mailing Address - Country:US
Mailing Address - Phone:561-985-0342
Mailing Address - Fax:
Practice Address - Street 1:3281 SW COHUTTA ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4647
Practice Address - Country:US
Practice Address - Phone:561-985-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9194155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine