Provider Demographics
NPI:1346881208
Name:DESIDER, TRICIA ANN (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:ANN
Last Name:DESIDER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BUERMANN AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7163
Mailing Address - Country:US
Mailing Address - Phone:727-688-2858
Mailing Address - Fax:
Practice Address - Street 1:1706 CORLIES AVE STE 5
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4977
Practice Address - Country:US
Practice Address - Phone:732-775-5005
Practice Address - Fax:732-775-0064
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14747500163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant