MEDICARE: MRS. LUCILLE ANN VANDEVERE APRN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP3283142	FL
2	363LF0000X	Family Nurse Practitioner	APRN3283142	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174577365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUCILLE ANN VANDEVERE APRN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 13300
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34979-3300
Country	:	US
Telephone Number	:	772-252-4130
Fax Number	:	772-672-4089

Provider Business Practice Location Address
First Line	:	1860 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4828
Country	:	US
Telephone Number	:	772-519-3005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/13/2024

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