Healthcare Provider Details

I. General information

NPI: 1699187591
Provider Name (Legal Business Name): MARY L DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY LYNN INMAN APRN

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/14/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 SIMPSON RD
KISSIMMEE FL
34744-5328
US

IV. Provider business mailing address

831 SIMPSON RD
KISSIMMEE FL
34744-5328
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-5757
  • Fax: 855-342-2122
Mailing address:
  • Phone: 407-483-5757
  • Fax: 855-342-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN2835352
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2835352
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAPRN2835352
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN2835352
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberARNP2835352
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD16083
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2835352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: