Healthcare Provider Details

I. General information

NPI: 1295032399
Provider Name (Legal Business Name): MS. BOBBIE ANN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6826 GADWALL LN
ORLANDO FL
32810-6064
US

IV. Provider business mailing address

5340 LONG RD APT E
ORLANDO FL
32808-1122
US

V. Phone/Fax

Practice location:
  • Phone: 407-285-1249
  • Fax:
Mailing address:
  • Phone: 407-285-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number017090100
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number239779
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number239779
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number239779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: