Healthcare Provider Details

I. General information

NPI: 1790976330
Provider Name (Legal Business Name): JENNIFER STARR DAVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER STARR BOYER PA-C

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date: 02/22/2019
Reactivation Date: 03/06/2019

III. Provider practice location address

2220 SE OCEAN BLVD STE 301
STUART FL
34996-3301
US

IV. Provider business mailing address

2336 SE OCEAN BLVD STE 145
STUART FL
34996-3310
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3339
  • Fax: 772-286-2635
Mailing address:
  • Phone: 772-220-3339
  • Fax: 772-286-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4357
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9104207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: