Provider Demographics
NPI:1932854726
Name:KRAMER, DESHIRE
Entity Type:Individual
Prefix:
First Name:DESHIRE
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3868 GRAND CENTRAL PL W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7638
Mailing Address - Country:US
Mailing Address - Phone:904-487-6011
Mailing Address - Fax:
Practice Address - Street 1:3868 GRAND CENTRAL PL W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7638
Practice Address - Country:US
Practice Address - Phone:904-487-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404841363LP0808X
CA95029716363LP0808X
FL11018191363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health