Healthcare Provider Details

I. General information

NPI: 1154270635
Provider Name (Legal Business Name): LAVERN LOGAN-PRYCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 NW FEDERAL HWY STE A
STUART FL
34994-9687
US

IV. Provider business mailing address

1607 NW FEDERAL HWY STE A
STUART FL
34994-9687
US

V. Phone/Fax

Practice location:
  • Phone: 772-480-5860
  • Fax: 772-264-8310
Mailing address:
  • Phone: 772-480-5860
  • Fax: 772-264-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11045097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: