Wallace Jerome Devries Jr., FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11000148 Issued in FL

Practice address

9009 Corporate Lake Dr
Tampa, FL 33634-2367

Phone

(763) 361-8001

NPI assigned

Nov 19, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1295204329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 E COWPEN LAKE POINT RD",
            "city": "HAWTHORNE",
            "state": "FL",
            "postal_code": "326405702",
            "telephone_number": "435-849-6896",
            "fax_number": "435-579-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9009 CORPORATE LAKE DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336342367",
            "telephone_number": "763-361-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVRIES",
        "first_name": "WALLACE",
        "middle_name": "JEROME",
        "name_suffix": "Jr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-19",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11000148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENCE NUMBER",
            "identifier": "11000148",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1912199415",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devoted Care Specialist LLC
• Devoteddoc FL PA
• Devoteddoc LLC
• Caleb Devries, DPT
• Jennifer Ann Devries, ARNP
• Johanna M Devryer, M.D.
• Deborah Julia Dewaay, M.D.
• Sarina R. Dewald, ARNP
• Erica Dewalt
• Nathan R Dewalt

• Family Nurse Practitioner in Tampa, FL
• Providers in Tampa, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.