MEDICARE: ANGELA BEATRICE DAVIS FNP-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
1	363LF0000X	Family Nurse Practitioner	RN2377383	MA

General Provider Information

NPI Number	:	1508434143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA BEATRICE DAVIS FNP-C

Provider Business Mailing Address
First Line	:	1575 BLUE HILL AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02126-2122
Country	:	US
Telephone Number	:	617-296-0061
Fax Number	:	617-296-5408

Provider Business Practice Location Address
First Line	:	1575 BLUE HILL AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02126-2122
Country	:	US
Telephone Number	:	229-200-1553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	02/06/2025

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