Provider Demographics
NPI:1003264292
Name:BUCK, DEVON (APN)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:FURTAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:610-382-4943
Mailing Address - Fax:610-878-3965
Practice Address - Street 1:316 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8805
Practice Address - Country:US
Practice Address - Phone:941-748-2277
Practice Address - Fax:941-748-1958
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00661100363LA2100X, 363LA2200X
FLARNP9457878363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health