Individual provider Active NPI

Eleanor W Devost

  • Nurse Practitioner
  • Starke, FL
National Provider Identifier
1518079409
Registry record updated Sep 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN804082 Issued in FL
Practice address
1801 N Temple Ave
Starke, FL 32091-1960
Phone
(904) 964-7732
Fax
(904) 964-3024
NPI assigned
Aug 31, 2006
Last updated
Sep 24, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN804082 FL Primary

Addresses

Primary practice location

1801 N Temple Ave
Starke, FL 32091-1960

Mailing address

1801 N Temple Ave
Starke, FL 32091-1960
Phone (904) 964-7732

Other identifiers 1

IdentifierTypeStateIssuer
304974400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN804082FLMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379980800000",
    "number": "1518079409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 N TEMPLE AVE",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320911960",
            "telephone_number": "904-964-7732",
            "fax_number": "904-964-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 N TEMPLE AVE",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320911960",
            "telephone_number": "904-964-7732",
            "fax_number": "904-964-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVOST",
        "first_name": "ELEANOR",
        "middle_name": "W",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "RN804082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304974400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Starke, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; 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.