Healthcare Provider Details

I. General information

NPI: 1922543891
Provider Name (Legal Business Name): JESSICA DAVIS L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 OAKHILL ST
SEFFNER FL
33584-4513
US

IV. Provider business mailing address

1111 OAKHILL ST
SEFFNER FL
33584-4513
US

V. Phone/Fax

Practice location:
  • Phone: 941-580-2007
  • Fax:
Mailing address:
  • Phone: 941-580-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5187722
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: