Provider Demographics
NPI:1679067383
Name:DESMARAIS, ROBERT JR (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DESMARAIS
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-7367
Mailing Address - Country:US
Mailing Address - Phone:352-572-8208
Mailing Address - Fax:
Practice Address - Street 1:3800 SE 44TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-7367
Practice Address - Country:US
Practice Address - Phone:352-572-8208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9228542163W00000X
FLAPRN11012324363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse