Provider Demographics
NPI:1891340618
Name:WILKES, DESEIRIA (APRN)
Entity Type:Individual
Prefix:
First Name:DESEIRIA
Middle Name:
Last Name:WILKES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1811
Mailing Address - Country:US
Mailing Address - Phone:727-459-3235
Mailing Address - Fax:
Practice Address - Street 1:14837 ELLINGSWORTH LN
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5673
Practice Address - Country:US
Practice Address - Phone:863-619-5100
Practice Address - Fax:727-231-0699
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner