Healthcare Provider Details

I. General information

NPI: 1003282310
Provider Name (Legal Business Name): RACHELL RENEE DAVIS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 03/20/2024
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 N MAGNOLIA AVE
ORLANDO FL
32803-3809
US

IV. Provider business mailing address

736 N MAGNOLIA AVE
ORLANDO FL
32803-3809
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-7149
  • Fax: 407-422-0470
Mailing address:
  • Phone: 407-423-7149
  • Fax: 407-422-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN83115
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11009288
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201505905NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: