# TREASURE COAST NEUROLOGY WEST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619921301
- **Authorized official:** LUCILLE ANN VANDEVERE ARNP (OWNER)
- **Authorized official phone:** (772) 873-1005

## Contact information

- **Practice address:** 1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT ST LUCIE, FL 34986-1709
- **Practice address phone:** (772) 873-1005
- **Practice address fax:** (772) 595-9986
- **Mailing address:** PO BOX 881565, PORT ST LUCIE, FL 34988-1565
- **Mailing address phone:** (772) 873-1005
- **Mailing address fax:** (772) 595-9986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | ARNP 3283142 | FL | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 08/22/2020