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General NPI Number Information
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NPI Number | 1750065025
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Entity Type | Organization
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Legal Business Name | DIVINE TELEHEALTH SERVICES LLC
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 6982 LAKESIDE RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2624
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Country | US
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Telephone | 561-349-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 6982 LAKESIDE RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2624
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Country | US
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Telephone | 561-349-5001
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAVERNE MITCHELL
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Credential | APRN
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Telephone | 561-349-5001
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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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