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General NPI Number Information
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NPI Number | 1073829966
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Entity Type | Individual
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Provider Name | JACQUES HERVE DESIR ARNP
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Gender | Male
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 2180 MARAVILLA LN STE 2
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City | FORT MYERS
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State | FL
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Zip | 33901-7221
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Country | US
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Telephone | 239-208-7756
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Fax | 239-208-7781
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Provider Business Mailing Address
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Address Line | 2180 MARAVILLA LN STE 2
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City | FORT MYERS
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State | FL
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Zip | 33901-7221
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Country | US
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Telephone | 239-645-3131
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Fax | 239-208-8775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9249044
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License Number State | FL
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