Healthcare Provider Details

I. General information

NPI: 1891404133
Provider Name (Legal Business Name): KERRY ANN DESARIE HOLDING RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 N ORANGE BLOSSOM TRL
KISSIMMEE FL
34744-2316
US

IV. Provider business mailing address

5011 LONDON CREEK PL
KISSIMMEE FL
34758-2279
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-6163
  • Fax:
Mailing address:
  • Phone: 407-799-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9455383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: