Provider Demographics
NPI:1487154746
Name:DESARMES, MICHELLE ROSE-MARIE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ROSE-MARIE
Last Name:DESARMES
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 S DIXIE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7461
Mailing Address - Country:US
Mailing Address - Phone:561-576-3074
Mailing Address - Fax:754-345-7764
Practice Address - Street 1:1650 S DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7461
Practice Address - Country:US
Practice Address - Phone:561-576-3074
Practice Address - Fax:754-345-7764
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000539363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102695200Medicaid
FL111508500Medicaid
FL102350900Medicaid