Provider Demographics
NPI:1275385643
Name:LAVERTTA MILLER APRN LLC
Entity Type:Organization
Organization Name:LAVERTTA MILLER APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAVERTTA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:239-427-5541
Mailing Address - Street 1:821 VISTANA CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-1004
Mailing Address - Country:US
Mailing Address - Phone:870-805-9625
Mailing Address - Fax:
Practice Address - Street 1:2430 VANDERBILT BEACH RD STE 108-573
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2654
Practice Address - Country:US
Practice Address - Phone:239-427-5541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty