Healthcare Provider Details

I. General information

NPI: 1942548094
Provider Name (Legal Business Name): NICOLE CATHERINE DAVIS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE CATHERINE BUCK ATC

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13837 CIRCA CROSSING DRIVE
LITHIA FL
33547
US

IV. Provider business mailing address

5808 27TH TER E
PALMETTO FL
34221-1279
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax:
Mailing address:
  • Phone: 636-614-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL4861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: