=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538084082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA NICOLE DAVIS APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2026
-----------------------------------------------------
Last Update Date | 08/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N MAIN ST
-----------------------------------------------------
City | CHATTAHOOCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32324-1107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-793-6058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20189 SW DOGWOOD AVE
-----------------------------------------------------
City | BLOUNTSTOWN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32424-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-766-6049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11049994
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------