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General NPI Number Information
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NPI Number | 1376012385
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Entity Type | Individual
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Provider Name | LARA LEE DEVERO-WILLIAMS APRN
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Gender | Female
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 635 1ST ST N
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4129
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Country | US
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Telephone | 863-294-0670
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Fax | 863-229-7620
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Provider Business Mailing Address
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Address Line | 2995 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-315-7496
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F11180234
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License Number State | FL
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