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General NPI Number Information
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NPI Number | 1538500400
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Entity Type | Individual
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Provider Name | ELLEN NICOLE DESIMONE A.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 200 BOOTH RD SUITE A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5715
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Country | US
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Telephone | 386-425-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 417 BLACK OAK LN
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City | ORMOND BEACH
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State | FL
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Zip | 32174-4897
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Country | US
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Telephone | 386-295-2258
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Fax |
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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 | ARNP9254081
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License Number State | FL
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