Healthcare Provider Details

I. General information

NPI: 1316537343
Provider Name (Legal Business Name): GEORGE DAVIS III APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 APPLEGATE DR
SPRING HILL FL
34606-4507
US

IV. Provider business mailing address

8635 HAWBUCK ST
TRINITY FL
34655-5307
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-3101
  • Fax: 352-688-8713
Mailing address:
  • Phone: 727-359-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11008726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: