Healthcare Provider Details

I. General information

NPI: 1780014951
Provider Name (Legal Business Name): DESIREE LYNNE KRASS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

1117 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4488
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-6301
  • Fax: 954-985-1434
Mailing address:
  • Phone: 954-454-5131
  • Fax: 954-241-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number9460399
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9460399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: