Healthcare Provider Details

I. General information

NPI: 1457928053
Provider Name (Legal Business Name): GABRIELLA DAMARIS DAVIS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAMARIS GABRIELLA DAVIS DPM

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 NW 71ST CT STE 204
TAMARAC FL
33321-2931
US

IV. Provider business mailing address

7710 NW 71ST CT STE 204
TAMARAC FL
33321-2931
US

V. Phone/Fax

Practice location:
  • Phone: 954-960-2168
  • Fax:
Mailing address:
  • Phone: 954-960-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: