Healthcare Provider Details

I. General information

NPI: 1952659872
Provider Name (Legal Business Name): NORMA JEAN DAVIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N TEMPLE AVE
STARKE FL
32091-1960
US

IV. Provider business mailing address

1801 N TEMPLE AVE
STARKE FL
32091-1960
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-7732
  • Fax: 904-964-3829
Mailing address:
  • Phone: 904-964-7732
  • Fax: 904-964-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3404822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: