Provider Demographics
NPI:1720313539
Name:DESARIO, MARY VIRGINIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VIRGINIA
Last Name:DESARIO
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:410 CELEBRATION PL
Mailing Address - Street 2:STE 306
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5436
Mailing Address - Country:US
Mailing Address - Phone:407-303-4855
Mailing Address - Fax:407-303-4404
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:STE 306
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747
Practice Address - Country:US
Practice Address - Phone:407-303-4855
Practice Address - Fax:407-303-4404
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2020-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9215062363LA2200X
FLAPRN9215062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health