Healthcare Provider Details

I. General information

NPI: 1407485188
Provider Name (Legal Business Name): MARIE DENISE DESIR P.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date: 06/19/2025
Reactivation Date: 12/08/2025

III. Provider practice location address

3890 TURTLE CREEK DR STE C
PORT ORANGE FL
32127-9352
US

IV. Provider business mailing address

3890 TURTLE CREEK DR STE C
PORT ORANGE FL
32127-9352
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-4400
  • Fax:
Mailing address:
  • Phone: 386-756-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11038212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: