Healthcare Provider Details

I. General information

NPI: 1275385643
Provider Name (Legal Business Name): LAVERTTA MILLER APRN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 VANDERBILT BEACH RD STE 108-573
NAPLES FL
34109-2654
US

IV. Provider business mailing address

821 VISTANA CIR
NAPLES FL
34119-1004
US

V. Phone/Fax

Practice location:
  • Phone: 239-427-5541
  • Fax:
Mailing address:
  • Phone: 870-805-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAVERTTA K MILLER
Title or Position: MANAGER
Credential: NP
Phone: 239-427-5541