Provider Demographics
NPI:1376706747
Name:DARIS, ISMENE
Entity type:Individual
Prefix:
First Name:ISMENE
Middle Name:
Last Name:DARIS
Suffix:
Gender:F
Credentials:
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 429
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34106-0429
Mailing Address - Country:US
Mailing Address - Phone:239-252-2513
Mailing Address - Fax:239-252-6016
Practice Address - Street 1:3301 TAMIAMI TRL E
Practice Address - Street 2:BUILDING H
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-3969
Practice Address - Country:US
Practice Address - Phone:239-252-2513
Practice Address - Fax:239-252-6016
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator