Provider Demographics
NPI:1306515754
Name:MILLS, DESIREE ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:ANN
Last Name:MILLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:24541 PACIFIC PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3050
Mailing Address - Country:US
Mailing Address - Phone:321-259-7111
Mailing Address - Fax:
Practice Address - Street 1:24541 PACIFIC PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3050
Practice Address - Country:US
Practice Address - Phone:321-259-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine