Provider Demographics
NPI:1073951000
Name:DEVITO, JACQUELYN MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MARIE
Last Name:DEVITO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8353 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5050
Mailing Address - Country:US
Mailing Address - Phone:727-304-1515
Mailing Address - Fax:727-335-2254
Practice Address - Street 1:1104 N PARSONS AVE STE D
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3133
Practice Address - Country:US
Practice Address - Phone:727-304-1515
Practice Address - Fax:727-471-5538
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9427836363L00000X
DCC-APN.0001940-C-NP363L00000X
COC-APN.0001940-C-NP363L00000X
NJNJDCATEMP-007508363L00000X
MA2292198363LF0000X
NY33338002363LF0000X
FL9427836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner