Treasure Coast Neurology West, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

ARNP 3283142 Issued in FL

Legal business name

TREASURE COAST NEUROLOGY WEST, LLC

Practice address

1420 SW Saint Lucie West Blvd
Suite 102
Port St Lucie, FL 34986-1709

Phone

(772) 873-1005

Fax

(772) 595-9986

NPI assigned

May 19, 2006

Organization subpart

No

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

Authorized official

Name

Lucille Ann Vandevere, ARNP

Title

Owner

Phone

(772) 873-1005

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick M. Gonzalez, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Port St Lucie, FL
  • NPI 1447364534
  NPD (past)
• Miguel Antonio Tabaro, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Cutler Bay, FL
  • NPI 1073538138
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619921301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 881565",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349881565",
            "telephone_number": "772-873-1005",
            "fax_number": "772-595-9986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 SW SAINT LUCIE WEST BLVD",
            "address_2": "SUITE 102",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861709",
            "telephone_number": "772-873-1005",
            "fax_number": "772-595-9986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREASURE COAST NEUROLOGY WEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VANDEVERE",
        "authorized_official_first_name": "LUCILLE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-873-1005",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "FL",
            "license": "ARNP 3283142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Treasure Coast Healthcare Associates,LLC
• Treasure Coast Medical and Holistic Care, LLC
• Treasure Coast Medical Centers, LLC
• Treasure Coast Medical Management, LLC
• Treasure Coast Medicine LLC
• Treasure Coast Neuropsychology PA
• Treasure Coast Optical, Inc.
• Treasure Coast Oral & Maxillofacial Surg & Dental Implant Surg Inc
• Treasure Coast Pathology, PA
• Treasure Coast Pathology, PA

• Multi-Specialty Clinic/Center in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.