Provider Demographics
NPI:1831740158
Name:DESANTIS, DANA SUE (APRN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:SUE
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:SUE
Other - Last Name:GOULETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:308 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2568
Mailing Address - Country:US
Mailing Address - Phone:863-824-7989
Mailing Address - Fax:863-763-0681
Practice Address - Street 1:308 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2568
Practice Address - Country:US
Practice Address - Phone:863-824-7989
Practice Address - Fax:863-638-5637
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004912363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily