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General NPI Number Information
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NPI Number | 1831799402
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Entity Type | Individual
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Provider Name | DESIREE DAVIS
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Gender | Female
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Dates
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Enumeration Date | 10/31/2020
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 4101 S HOSPITAL DR
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City | PLANTATION
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State | FL
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Zip | 33317-2857
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Country | US
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Telephone | 954-446-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 5221 NW 22ND ST
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City | LAUDERHILL
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State | FL
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Zip | 33313-3230
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Country | US
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Telephone | 404-285-2110
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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 | 9369084
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License Number State | FL
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