=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003264292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEVON BUCK APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2016
-----------------------------------------------------
Last Update Date | 10/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 MANATEE AVE W
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34205-8805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-748-2277
-----------------------------------------------------
Fax | 941-748-1958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 367 S. GULPH RD ATT IPM CREDENTIALING
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-382-4943
-----------------------------------------------------
Fax | 610-878-3965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00661100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00661100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9457878
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------