Provider Demographics
NPI:1760227185
Name:DEVORE, LAURA M (PMHNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:DEVORE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 LAKE HEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33956-2614
Mailing Address - Country:US
Mailing Address - Phone:419-341-0198
Mailing Address - Fax:
Practice Address - Street 1:3191 HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6755
Practice Address - Country:US
Practice Address - Phone:239-690-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033292363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health