Destined for Change LLC

Primary specialty

HomemakerTaxonomy code 376J00000X

Legal business name

DESTINED FOR CHANGE LLC

Practice address

2094 W Busch Blvd
Tampa, FL 33612-7568

Phone

(813) 867-0053

Fax

(877) 349-6369

NPI assigned

Dec 13, 2017

Organization subpart

No

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

Authorized official

Name

Chavarra Simmons

Title

Executive Director

Phone

(813) 867-0053

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630972800000",
    "number": "1720593627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2094 W BUSCH BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336127568",
            "telephone_number": "813-867-0053",
            "fax_number": "877-349-6369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2094 W BUSCH BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336127568",
            "telephone_number": "813-867-0053",
            "fax_number": "877-349-6369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 E Jackson St Ste 2340",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336025226",
            "country_code": "US",
            "telephone_number": "813-867-0053",
            "fax_number": "813-867-0054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DESTINED FOR CHANGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "CHAVARRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "813-867-0053"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chrystelle Aviahna Desrosiers, WHNP
• Mary Desrosiers
• Megan Desrosiers, M.A., LMHC, CAP
• Sophie Dessureault, MD, PHD
• Natalie Rose Destefano, PT, DPT
• Guilaine Destrat
• Giovanna Destri
• Oleg V Desyatnikov, DO
• Brianna Detamore
• Michelle Deterding, CRNA

• Homemaker in Tampa, FL
• Providers in Tampa, FL by specialty
• Homemaker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.