Healthcare Provider Details

I. General information

NPI: 1801720461
Provider Name (Legal Business Name): ANTIONETTE MARIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 79TH ST APT 215
MIAMI FL
33150-3132
US

IV. Provider business mailing address

1150 NW 79TH ST APT 215
MIAMI FL
33150-3132
US

V. Phone/Fax

Practice location:
  • Phone: 786-454-6696
  • Fax:
Mailing address:
  • Phone: 786-454-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: