Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP3053732 | FL |
NPI | 1003845793 |
---|---|
Provider Name | Ms. Christine Desantis |
First Address | Tavares, FL 32778 |
Second Address | Tavares, FL 32778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 30/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
303915300 | (05) | FL |