Provider Demographics
NPI:1164715074
Name:DESRAVINES, LORRAINE YVONNE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:YVONNE
Last Name:DESRAVINES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3381 CELEBRATION LN
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8231
Mailing Address - Country:US
Mailing Address - Phone:954-415-1928
Mailing Address - Fax:
Practice Address - Street 1:7111 FAIRWAY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4204
Practice Address - Country:US
Practice Address - Phone:561-799-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254156367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered