Healthcare Provider Details

I. General information

NPI: 1932029071
Provider Name (Legal Business Name): DAVIDSON INNOCENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 COLLIER BLVD
NAPLES FL
34114-3549
US

IV. Provider business mailing address

8300 COLLIER BLVD
NAPLES FL
34114-3549
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-6404
  • Fax:
Mailing address:
  • Phone: 239-354-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9498926
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11046916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: