Provider Demographics
NPI:1043269632
Name:DORRIS, GERALDINE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:DORRIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 IMMOKALEE RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1421
Mailing Address - Country:US
Mailing Address - Phone:239-287-1493
Mailing Address - Fax:239-244-9357
Practice Address - Street 1:2180 IMMOKALEE RD
Practice Address - Street 2:SUITE 216
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1421
Practice Address - Country:US
Practice Address - Phone:239-287-1493
Practice Address - Fax:239-244-9357
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3344802363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302889500Medicaid
FLP00066423OtherRAIL ROAD MEDICARE
FL302889500Medicaid