Provider Demographics
NPI:1134797384
Name:KALAROVICH, DESIREE A (RN)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:KALAROVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6171
Mailing Address - Country:US
Mailing Address - Phone:352-551-8401
Mailing Address - Fax:352-805-4124
Practice Address - Street 1:225 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6171
Practice Address - Country:US
Practice Address - Phone:352-551-8401
Practice Address - Fax:352-805-4124
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13534310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9268428OtherREGISTERED NURSE