Healthcare Provider Details

I. General information

NPI: 1255066189
Provider Name (Legal Business Name): JAIME NICOLE DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1876 N BROAD ST
FUQUAY VARINA NC
27526-3657
US

IV. Provider business mailing address

1876 N BROAD ST
FUQUAY VARINA NC
27526-3657
US

V. Phone/Fax

Practice location:
  • Phone: 984-265-2101
  • Fax:
Mailing address:
  • Phone: 984-265-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016585
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: