Organization
TREASURE COAST NEUROLOGY WEST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCILLE ANN VANDEVERE ARNP (OWNER)
(772) 873-1005
Entity
Organization
Contact information
Practice address
1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT ST LUCIE, FL 34986-1709
(772) 873-1005
(772) 595-9986
Mailing address
PO BOX 881565, PORT ST LUCIE, FL 34988-1565
(772) 873-1005
(772) 595-9986
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
ARNP 3283142
FL
Other
Enumeration date
05/19/2006
Last updated
08/22/2020
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