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General NPI Number Information
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NPI Number | 1134609704
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Entity Type | Individual
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Provider Name | DAVID WAYNE DAVIS
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Gender | Male
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 238 SW CULLEN AVE
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City | FORT WHITE
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State | FL
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Zip | 32038-3536
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Country | US
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Telephone | 386-497-1397
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Fax |
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Provider Business Mailing Address
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Address Line | 238 SW CULLEN AVE
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City | FORT WHITE
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State | FL
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Zip | 32038-3536
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Country | US
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Telephone | 386-497-1397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9384698
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License Number State | FL
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