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General NPI Number Information
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NPI Number | 1639642242
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Entity Type | Individual
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Provider Name | DANIELLE ANN DAVIS APRN
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Gender | Female
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 2150 SW TRENTON LN
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4325
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Country | US
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Telephone | 561-603-4043
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 SW TRENTON LN
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4325
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Country | US
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Telephone | 561-603-4043
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11000768
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License Number State | FL
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