Healthcare Provider Details

I. General information

NPI: 1376012385
Provider Name (Legal Business Name): LARA LEE DEVERO-WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 1ST ST N
WINTER HAVEN FL
33881-4129
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-0670
  • Fax: 863-229-7620
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11180234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: