=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992296768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA VENETTA DAVIS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2018
-----------------------------------------------------
Last Update Date | 12/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15655 W ROOSEVELT ST STE 214
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85338-9306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-344-9737
-----------------------------------------------------
Fax | 888-587-2701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15655 W ROOSEVELT ST STE 214
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85338-9306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-344-9737
-----------------------------------------------------
Fax | 888-587-2701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Nurse Practitioner
-----------------------------------------------------
License Number | AP11679
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP11679
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | AP11679
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------