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General NPI Number Information
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NPI Number | 1174577365
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Entity Type | Individual
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Provider Name | LUCILLE ANN VANDEVERE APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 01/13/2024
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Provider Practice Location Address
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Address Line | 1860 N LAWNWOOD CIR
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City | FORT PIERCE
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State | FL
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Zip | 34950-4828
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Country | US
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Telephone | 772-519-3005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13300
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City | FORT PIERCE
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State | FL
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Zip | 34979-3300
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Country | US
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Telephone | 772-252-4130
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Fax | 772-672-4089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP3283142
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN3283142
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License Number State | FL
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