LINDA DESRUISSEAU-REVIS APRN CNP NPI 1912459728

NPI Information

NPI: 1912459728
Provider Name: LINDA DESRUISSEAU-REVIS, APRN, CNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: DIAGNOSTIC CLINIC MEDICAL GROUP INC

PECOS Registration: Yes

Address:
3131 N MCMULLEN BOOTH RD
CLEARWATER, FL
ZIP 33761
Phone: (727) 726-8871
Get Directions

Linda Desruisseau-revis, APRN, CNP is a family nurse practitioner in Clearwater, FL with 8 years of experience. Linda Desruisseau-revis, APRN, CNP NPI is 1912459728. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3131 N MCMULLEN BOOTH RD
CLEARWATER, FL
ZIP 33761-008
Phone: (727) 726-8871
Fax: (727) 588-9478

The NPI 1912459728 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/27/2016 and was last updated on 12/5/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	ARNP9490973	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5030780	OTHER	FLORIDA	AETNA
2	6287578	OTHER	FLORIDA	UNITED
3	101395400	MEDICAID	FLORIDA
4	8270292	OTHER	FLORIDA	CIGNA
5	48EHI	OTHER	FLORIDA	FLORIDA BLUE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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