Healthcare Provider Details

I. General information

NPI: 1013624253
Provider Name (Legal Business Name): LUCIE DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 02/15/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 CHASEWOOD DR
SAINT AUGUSTINE FL
32095-7909
US

IV. Provider business mailing address

400 HEALTH PARK BLVD
SAINT AUGUSTINE FL
32086-5784
US

V. Phone/Fax

Practice location:
  • Phone: 408-759-2838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN110225579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: