Doreen Destefano

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APRN1100138 Issued in FL

Practice address

12734 Kenwood LN Ste 84
Fort Myers, FL 33907-5638

Phone

(239) 425-2900

Fax

(239) 791-1072

NPI assigned

Aug 21, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 5, 2020 through Oct 5, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552435200000",
    "number": "1215417951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12734 KENWOOD LN STE 84",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075638",
            "telephone_number": "239-425-2900",
            "fax_number": "239-791-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12734 KENWOOD LN STE 84",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075638",
            "telephone_number": "239-425-2900",
            "fax_number": "239-791-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "DOREEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2019-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN1100138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Michelle Desomma, A.R.N.P.
• Laurie J Desouza, ARNP
• Joseph E Dessent IV, D.O.
• Kelsie Dessent
• Therese Dessoye, PA-C
• Elta Desvaristes, PA-C
• Johnna Lynn Dettis, ARNP
• Samantha Lower Dettmar, MS
• Katherine Deutch
• Kanagasab Deva Caanthan, MD

• Adult Health Nurse Practitioner in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.