Provider Demographics
NPI:1689117574
Name:DESUEZA, FRANK GUILLERMO (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:GUILLERMO
Last Name:DESUEZA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:647 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-6500
Mailing Address - Country:US
Mailing Address - Phone:917-322-9824
Mailing Address - Fax:718-676-1411
Practice Address - Street 1:647 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-6500
Practice Address - Country:US
Practice Address - Phone:917-322-9824
Practice Address - Fax:718-676-1411
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338476-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily