MEDICARE: DEVIN D DISCALA ARNP

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	ARNP9258220	FL

General Provider Information

NPI Number	:	1205264165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN D DISCALA ARNP

Provider Business Mailing Address
First Line	:	600 E. DIXIE AVENUE
Second Line	:	ATTN: EDNA P - CREDENTIALING
City	:	LEESBURG
State	:	FL
Zip	:	34748
Country	:	US
Telephone Number	:	352-323-4267
Fax Number	:	352-323-5039

Provider Business Practice Location Address
First Line	:	1149 MAIN ST
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-7721
Country	:	US
Telephone Number	:	352-674-2080
Fax Number	:	352-674-2177

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

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	05/10/2017

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