Healthcare Provider Details

I. General information

NPI: 1881424380
Provider Name (Legal Business Name): MARY PARKER DAVIDSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 SUNBEAM RD STE 101
JACKSONVILLE FL
32257-6188
US

IV. Provider business mailing address

PO BOX 13834
TALLAHASSEE FL
32317-3834
US

V. Phone/Fax

Practice location:
  • Phone: 904-512-1899
  • Fax: 904-770-7592
Mailing address:
  • Phone: 850-205-6232
  • Fax: 850-975-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11033716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: