Provider Demographics
NPI:1780014951
Name:KRASS, DESIREE LYNNE (ARNP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:LYNNE
Last Name:KRASS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4488
Mailing Address - Country:US
Mailing Address - Phone:954-454-5131
Mailing Address - Fax:954-241-6908
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-265-6301
Practice Address - Fax:954-985-1434
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9460399363LP0222X, 363LP0200X
TNAPN0000017960363LP0200X, 363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1780014951Medicaid
SCNP3476Medicaid
NCNCQ327AMedicare PIN