Healthcare Provider Details

I. General information

NPI: 1306936893
Provider Name (Legal Business Name): KATRINA DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 BEE RIDGE RD
SARASOTA FL
34239-6304
US

IV. Provider business mailing address

101 EYSTER BLVD
ROCKLEDGE FL
32955-3608
US

V. Phone/Fax

Practice location:
  • Phone: 941-343-0609
  • Fax:
Mailing address:
  • Phone: 321-806-3929
  • Fax: 877-362-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME119712
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME119712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: