Healthcare Provider Details

I. General information

NPI: 1407140478
Provider Name (Legal Business Name): LEANN C DAVIDSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 BRICKYARD RD STE 5
CHIPLEY FL
32428-6392
US

IV. Provider business mailing address

1376 BRICKYARD RD STE 5
CHIPLEY FL
32428-6392
US

V. Phone/Fax

Practice location:
  • Phone: 850-415-6781
  • Fax: 850-415-6783
Mailing address:
  • Phone: 850-415-6781
  • Fax: 850-415-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3402062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: