MEDICARE: KERRY ANN DESARIE HOLDING RN, BSN

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	163WE0003X	Emergency Registered Nurse	RN9455383	FL
2	363LF0000X	Family Nurse Practitioner	APRN11037415	FL

General Provider Information

NPI Number	:	1891404133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY ANN DESARIE HOLDING RN, BSN

Provider Business Mailing Address
First Line	:	PO BOX 4189
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-4189
Country	:	US
Telephone Number	:	954-363-9582
Fax Number	:	954-363-9663

Provider Business Practice Location Address
First Line	:	2550 SIMPSON RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4637
Country	:	US
Telephone Number	:	407-632-4217
Fax Number	:	407-632-4226

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	01/06/2026

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