Provider Demographics
NPI:1558539239
Name:DEVLIN, LAURA ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 9TH AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7148
Mailing Address - Country:US
Mailing Address - Phone:727-266-1404
Mailing Address - Fax:
Practice Address - Street 1:2191 9TH AVE N STE 200
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7148
Practice Address - Country:US
Practice Address - Phone:727-266-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195508001Medicaid
TX8Y4001OtherBLUE CROSS BLUE SHIELD
TX8Y9489OtherBLUE CROSS BLUE SHIELD
TX195508003Medicaid
TX8DY4001OtherBLUE CROSS BLUE SHIELD
TXP00783100OtherMEDICARE RAILROAD
TX195508002Medicaid
TXP01074746OtherRR MEDICARE
TX195508002Medicaid
TX483321YUD8Medicare PIN
TXP01074746OtherRR MEDICARE
TXTXB138407Medicare PIN
TX8Y9489OtherBLUE CROSS BLUE SHIELD
TX8DY4001OtherBLUE CROSS BLUE SHIELD