Provider Demographics
NPI:1982011508
Name:DEVOSE, FUSUN (NP)
Entity Type:Individual
Prefix:
First Name:FUSUN
Middle Name:
Last Name:DEVOSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SORAYA
Other - Middle Name:
Other - Last Name:DEVOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:3408 S ATLANTIC AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-6311
Mailing Address - Country:US
Mailing Address - Phone:321-213-9452
Mailing Address - Fax:321-425-8530
Practice Address - Street 1:1010 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2507
Practice Address - Country:US
Practice Address - Phone:919-287-2897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX785972163W00000X
CA820736163W00000X
FLARNP9367087363LF0000X
TXAP126685363LF0000X
NC5011347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5011347OtherNURSE PRACTITIONER LICENSE