Healthcare Provider Details

I. General information

NPI: 1013973593
Provider Name (Legal Business Name): SUSAN P DAVIS AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E VENICE AVE SERENITY GARDENS
VENICE FL
34285
US

IV. Provider business mailing address

1790 POMELO DR BILLING DEPT
VENICE FL
34293-2716
US

V. Phone/Fax

Practice location:
  • Phone: 941-716-5170
  • Fax: 941-497-2735
Mailing address:
  • Phone: 941-493-8596
  • Fax: 941-496-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: