Healthcare Provider Details

I. General information

NPI: 1558175562
Provider Name (Legal Business Name): NICOLE DAVIS FNP-C, ENP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3098 W EXECUTIVE PKWY STE 300
LEHI UT
84048-4911
US

IV. Provider business mailing address

3098 W EXECUTIVE PKWY STE 300
LEHI UT
84048-4911
US

V. Phone/Fax

Practice location:
  • Phone: 801-349-2480
  • Fax: 385-900-1671
Mailing address:
  • Phone: 801-349-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7921527-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: