Healthcare Provider Details

I. General information

NPI: 1215097746
Provider Name (Legal Business Name): ESTHER LOUISE DAVIS ADVANCED PRACTICE MI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTHER LOUISE WILSON ADVANCED PRACTICE MI

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE STE 307
PENSACOLA FL
32504-5719
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6378
  • Fax: 850-416-2278
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1051239
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11006773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: