MEDICARE: MS. DESITHA MERTILUS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	APRN2904452	FL
2	363L00000X	Nurse Practitioner	ARNP2904452	FL
3	363LF0000X	Family Nurse Practitioner	APRN2904452	FL
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN2904452	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487132668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DESITHA MERTILUS ARNP

Provider Business Mailing Address
First Line	:	2636 SW 129TH TER
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3851
Country	:	US
Telephone Number	:	954-562-8670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4611
Country	:	US
Telephone Number	:	954-276-9700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	04/09/2026

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