Provider Demographics
NPI:1326755653
Name:BURKE, DESIREE NICOLE (PMHNP-BC, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:NICOLE
Last Name:BURKE
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12298 SAWGRASS CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4878
Mailing Address - Country:US
Mailing Address - Phone:917-273-1357
Mailing Address - Fax:
Practice Address - Street 1:1490 ROYAL PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1608
Practice Address - Country:US
Practice Address - Phone:561-635-3311
Practice Address - Fax:844-210-5550
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115314363LP0808X
IAG178922363LP0808X
FL11014280363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health