Provider Demographics
NPI:1154947307
Name:DARRISAW, DESIREE JANELL (CHNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:JANELL
Last Name:DARRISAW
Suffix:
Gender:F
Credentials:CHNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 TINTON AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-2217
Mailing Address - Country:US
Mailing Address - Phone:917-969-0114
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-3408
Practice Address - Fax:212-305-4085
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320095363LF0000X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily