Provider Demographics
NPI:1740916949
Name:DOUGLAS, DESIREE A (APRN)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:DOUGLAS
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 1:6698 297TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1615
Mailing Address - Country:US
Mailing Address - Phone:239-633-5221
Mailing Address - Fax:
Practice Address - Street 1:13908 LAKESHORE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1492
Practice Address - Country:US
Practice Address - Phone:727-846-9419
Practice Address - Fax:727-848-6200
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9337405363LG0600X
FLAPRN11011189363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology