Provider Demographics
NPI:1477194470
Name:DORMEVIL, KARL HENRY (APRN)
Entity type:Individual
Prefix:
First Name:KARL HENRY
Middle Name:
Last Name:DORMEVIL
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-1664
Mailing Address - Country:US
Mailing Address - Phone:561-704-8352
Mailing Address - Fax:
Practice Address - Street 1:2465 S STATE ROAD 7 STE 800
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9348
Practice Address - Country:US
Practice Address - Phone:561-784-4930
Practice Address - Fax:833-625-1635
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038892363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care