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General NPI Number Information
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NPI Number | 1013789718
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Entity Type | Organization
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Legal Business Name | NP ON DUTY LLC
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 911 S PARSONS AVE STE H
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City | BRANDON
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State | FL
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Zip | 33511-6042
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Country | US
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Telephone | 813-729-4269
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Fax |
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Provider Business Mailing Address
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Address Line | 911 S PARSONS AVE STE H
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City | BRANDON
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State | FL
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Zip | 33511-6042
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Country | US
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Telephone | 813-729-4269
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LEONNE M DERAVINE
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Credential |
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Telephone | 813-278-2044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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