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NPI Code Detail

MEDICARE: MRS. TINA M DAVIS PA C

MEDICARE:  MRS. TINA M DAVIS  PA C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant50-00-1480OH
2363AM0700XMedical Physician Assistant50.001480RXOH

General Provider Information

NPI Number : 1316929300
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TINA M DAVIS PA C
Provider Business Mailing Address
First Line : 3574 CENTER RD
Second Line :
City : BRUNSWICK
State : OH
Zip : 44212-3618
Country : US
Telephone Number : 330-225-8886
Fax Number :
Provider Business Practice Location Address
First Line : 3574 CENTER RD
Second Line :
City : BRUNSWICK
State : OH
Zip : 44212-3618
Country : US
Telephone Number : 330-225-8886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 10/03/2022

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Directions to “ MRS. TINA M DAVIS PA C” Practice Location

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