Provider Demographics
NPI:1811627961
Name:DESIMONE, ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HEATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6620 FLY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4282
Mailing Address - Country:US
Mailing Address - Phone:315-464-4259
Mailing Address - Fax:315-464-9393
Practice Address - Street 1:6620 FLY RD STE 200
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-5076
Practice Address - Country:US
Practice Address - Phone:315-464-4259
Practice Address - Fax:315-464-9393
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily