Healthcare Provider Details

I. General information

NPI: 1760304778
Provider Name (Legal Business Name): DACIA CHRISTINA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 DRUMCLIFF DR APT 1219
MATTHEWS NC
28105-5183
US

IV. Provider business mailing address

3125 DRUMCLIFF DR APT 1219
MATTHEWS NC
28105-5183
US

V. Phone/Fax

Practice location:
  • Phone: 309-839-3350
  • Fax:
Mailing address:
  • Phone: 309-839-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: