MEDICARE: LAVERTTA K WHITE 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	363LF0000X	Family Nurse Practitioner	0024189886	VA
2	363LF0000X	Family Nurse Practitioner	0100353	CO
3	363LF0000X	Family Nurse Practitioner	LG-0013020	DE
4	363LF0000X	Family Nurse Practitioner	9470582	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	:	1174907679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVERTTA K WHITE APRN, FNP-BC

Provider Business Mailing Address
First Line	:	2430 VANDERBILT BEACH RD STE 108-573
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2654
Country	:	US
Telephone Number	:	239-348-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 VANDERBILT BEACH RD STE 108-573
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2654
Country	:	US
Telephone Number	:	239-348-4221
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	04/09/2025

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