Healthcare Provider Details

I. General information

NPI: 1609490986
Provider Name (Legal Business Name): LAUREN A DAVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN A MUNYAN PA-C

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SW 22ND PL
OCALA FL
34471-7766
US

IV. Provider business mailing address

5580 NE 20TH AVE
OCALA FL
34479-7183
US

V. Phone/Fax

Practice location:
  • Phone: 352-368-1350
  • Fax: 352-237-7728
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: