Provider Demographics
NPI:1518675156
Name:DERINOR, MARA-JOANNE (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARA-JOANNE
Middle Name:
Last Name:DERINOR
Suffix:
Gender:
Credentials:DNP, 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:PO BOX 423356
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-3356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 423356
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34742-3356
Practice Address - Country:US
Practice Address - Phone:347-460-9989
Practice Address - Fax:407-337-0137
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023083363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health