Provider Demographics
NPI:1649742628
Name:JOSEPH, VIERGELA DESHOMMES (APRN)
Entity Type:Individual
Prefix:
First Name:VIERGELA
Middle Name:DESHOMMES
Last Name:JOSEPH
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 1:610 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-7545
Mailing Address - Country:US
Mailing Address - Phone:239-603-3734
Mailing Address - Fax:239-603-3734
Practice Address - Street 1:10501 6 MILE CYPRESS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6400
Practice Address - Country:US
Practice Address - Phone:239-355-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-01
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000711363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care