Healthcare Provider Details

I. General information

NPI: 1386915627
Provider Name (Legal Business Name): NICOLE ELAINE DAVIS MD, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 US HIGHWAY 27 N STE 201
SEBRING FL
33870-8226
US

IV. Provider business mailing address

1109 E FAIRVIEW AVE APT 300
MONTGOMERY AL
36106-2239
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-9600
  • Fax: 863-382-0107
Mailing address:
  • Phone: 205-617-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14302
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME162422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: