Healthcare Provider Details

I. General information

NPI: 1508434143
Provider Name (Legal Business Name): ANGELA BEATRICE DAVIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BLUE HILL AVE
BOSTON MA
02126-2122
US

IV. Provider business mailing address

1575 BLUE HILL AVE
BOSTON MA
02126-2122
US

V. Phone/Fax

Practice location:
  • Phone: 229-200-1553
  • Fax:
Mailing address:
  • Phone: 617-296-0061
  • Fax: 617-296-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2377383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: