Provider Demographics
NPI:1972290740
Name:MEEK, MISTY M (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:MEEK
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-3492
Mailing Address - Fax:239-424-4030
Practice Address - Street 1:650 DEL PRADO BLVD S STE 106
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5617
Practice Address - Country:US
Practice Address - Phone:239-424-3492
Practice Address - Fax:239-424-4030
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118174400Medicaid