MEDICARE: DEVON ELIZABETH DRIVER 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	RN218402	GA

General Provider Information

NPI Number	:	1821432899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON ELIZABETH DRIVER FNP-BC

Provider Business Mailing Address
First Line	:	220 GRACES WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-1613
Country	:	US
Telephone Number	:	803-736-4560
Fax Number	:	803-744-1217

Provider Business Practice Location Address
First Line	:	220 GRACES WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-1613
Country	:	US
Telephone Number	:	803-736-4560
Fax Number	:	803-744-1217

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	07/16/2024

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