Healthcare Provider Details

I. General information

NPI: 1023529500
Provider Name (Legal Business Name): HEATHER RENEE DAVIS DNP, APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 COUNTY ROAD 352
KEYSTONE HEIGHTS FL
32656-7741
US

IV. Provider business mailing address

5575 COUNTY ROAD 352
KEYSTONE HEIGHTS FL
32656-7741
US

V. Phone/Fax

Practice location:
  • Phone: 352-224-5220
  • Fax:
Mailing address:
  • Phone: 352-224-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9295668
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP9295668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: