Healthcare Provider Details

I. General information

NPI: 1821926635
Provider Name (Legal Business Name): LAILA DESIREE WHITE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 BOBCAT VILLAGE CENTER RD
NORTH PORT FL
34288-8974
US

IV. Provider business mailing address

13370 DRYSDALE AVE
PORT CHARLOTTE FL
33981-2112
US

V. Phone/Fax

Practice location:
  • Phone: 941-266-5629
  • Fax:
Mailing address:
  • Phone: 717-339-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN9609837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: