Individual
MRS. DESIREE ELIZABETH KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
1350 HICKORY ST STE 101, MELBOURNE, FL 32901-3224
(321) 434-3644
(321) 434-3438
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-3644
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11019009
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116208900
—
FL
01
—
PZ316
MEDICARE HF
FL
Enumeration date
04/05/2022
Last updated
12/02/2022
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