Provider Demographics
NPI:1700401650
Name:DESIR, PATRICK (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:DESIR
Suffix:
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 1:9800 4TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2462
Mailing Address - Country:US
Mailing Address - Phone:727-201-5470
Mailing Address - Fax:727-569-5359
Practice Address - Street 1:9800 4TH ST N
Practice Address - Street 2:STE 200
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2462
Practice Address - Country:US
Practice Address - Phone:727-201-5470
Practice Address - Fax:727-569-5359
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007575363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health