Individual provider Active NPI

Laura M Devore, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Port Charlotte, FL
National Provider Identifier
1760227185
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
11033292 Issued in FL
Practice address
3191 Harbor Blvd Ste a
Port Charlotte, FL 33952-6755
Phone
(239) 690-6906
NPI assigned
Jun 27, 2024
Last updated
Oct 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 11033292 FL Primary

Addresses

Primary practice location

3191 Harbor Blvd Ste a
Port Charlotte, FL 33952-6755

Mailing address

4424 Lake Heather Cir
Saint James City, FL 33956-2614
Phone (419) 341-0198

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241031001917 FL Practitioner - Nurse Practitioner 9234662073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3191 Harbor Blvd
Suite a
Port Charlotte, FL 33952-6755
Phone (941) 883-4518

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11033292FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dna Comprehensive Therapy Services, LLC CurrentSince Oct 24, 2024 Accepting new patients
Bonita Springs Retirement Village, Inc. CurrentSince Oct 24, 2024 Accepting new patients

Locations

4310 Metro Pkwy
Ste 205
Fort Myers, FL 33916

3191 Harbor Blvd
Ste A
Pt Charlotte, FL 33952
Phone (941) 766-9555

5825 Argerian Dr
Ste 101
Wesley Chapel, FL 33545
Phone (813) 687-4870

Interoperability endpoints

  • Direct secure messaging: laura.devore.1@13142.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1760227185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4424 LAKE HEATHER CIR",
            "city": "SAINT JAMES CITY",
            "state": "FL",
            "postal_code": "339562614",
            "telephone_number": "419-341-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3191 HARBOR BLVD STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526755",
            "telephone_number": "239-690-6906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVORE",
        "first_name": "LAURA",
        "middle_name": "M",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11033292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.