Provider Demographics
NPI:1073829966
Name:DESIR, JACQUES HERVE (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:HERVE
Last Name:DESIR
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 MARAVILLA LN
Mailing Address - Street 2:STE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7221
Mailing Address - Country:US
Mailing Address - Phone:239-645-3131
Mailing Address - Fax:239-208-8775
Practice Address - Street 1:2180 MARAVILLA LN STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7221
Practice Address - Country:US
Practice Address - Phone:239-208-7756
Practice Address - Fax:239-208-7781
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9249044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75062740OtherPRESTIGE
FL255810OtherUNITED
FLY05NROtherBCBS
FL002961100Medicaid
FLDZ407XMedicare Oscar/Certification