Provider Demographics
NPI:1275128241
Name:HARTZELL, DESIREE LYNNE (APRN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:LYNNE
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12356 STREAMBED DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-9305
Mailing Address - Country:US
Mailing Address - Phone:352-217-0160
Mailing Address - Fax:
Practice Address - Street 1:12356 STREAMBED DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-9305
Practice Address - Country:US
Practice Address - Phone:352-217-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011918363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care