Provider Demographics
NPI:1467919928
Name:BOURG, DEVONN LINDSEY (MSN, ARNP, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:DEVONN
Middle Name:LINDSEY
Last Name:BOURG
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-C
Other - Prefix:MISS
Other - First Name:DEVONN
Other - Middle Name:LINDSEY
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5370 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-6826
Mailing Address - Country:US
Mailing Address - Phone:850-686-7733
Mailing Address - Fax:
Practice Address - Street 1:5370 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-6826
Practice Address - Country:US
Practice Address - Phone:506-867-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily