Provider Demographics
NPI:1306997192
Name:DESANTIS, JOSEPH (ARNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 NW 10TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1013
Mailing Address - Country:US
Mailing Address - Phone:305-243-4546
Mailing Address - Fax:305-243-5562
Practice Address - Street 1:1580 NW 10TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1013
Practice Address - Country:US
Practice Address - Phone:305-243-4546
Practice Address - Fax:305-243-5562
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2865622363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3031454-00Medicaid
FL3031454-00Medicaid
FLY9258Medicare ID - Type Unspecified
FLP098183Medicare UPIN