Healthcare Provider Details

I. General information

NPI: 1336535517
Provider Name (Legal Business Name): MICHELLE R DAVIS AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 N 103RD AVE., BLDG F STE 6-7
SUN CITY AZ
85351-3028
US

IV. Provider business mailing address

500 W THOMAS RD STE 500
PHOENIX AZ
85013-4220
US

V. Phone/Fax

Practice location:
  • Phone: 602-425-0030
  • Fax: 877-819-9027
Mailing address:
  • Phone: 602-406-4000
  • Fax: 602-406-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAZ7614
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP7614
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: