Provider Demographics
NPI:1326683731
Name:ACKERMAN, DESIRAE MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:MARIE
Last Name:ACKERMAN
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 1:3310 BERMUDA ISLE CIR APT 222
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2644
Mailing Address - Country:US
Mailing Address - Phone:973-271-4258
Mailing Address - Fax:
Practice Address - Street 1:3310 BERMUDA ISLE CIR APT 222
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2644
Practice Address - Country:US
Practice Address - Phone:973-271-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9343786163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical