Provider Demographics
NPI:1912717414
Name:ORR, MISTY A (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:A
Last Name:ORR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5884
Mailing Address - Country:US
Mailing Address - Phone:321-427-4939
Mailing Address - Fax:
Practice Address - Street 1:600 N US HIGHWAY 17 92 STE 24
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3624
Practice Address - Country:US
Practice Address - Phone:407-876-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9416453163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse