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NPI Code Detail

MEDICARE: STACEY MICHEL DAVIS, LLC

MEDICARE: STACEY MICHEL DAVIS, LLC
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
1363LF0000XFamily Nurse PractitionerARNP9223841FL

General Provider Information

NPI Number : 1518243476
Entity Type Code : Organization
Provider Name (Legal Business Name) : STACEY MICHEL DAVIS, LLC
Provider Business Mailing Address
First Line : 11672 SPRING BOARD DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-7574
Country : US
Telephone Number : 904-993-1259
Fax Number :
Provider Business Practice Location Address
First Line : 4217 BAYMEADOWS RD STE 3
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-4676
Country : US
Telephone Number : 904-332-7431
Fax Number : 904-332-7408
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : MRS. STACEY MICHEL DAVIS
Credential : ARNP
Telephone Number : 904-993-1259
Provider Enumeration Date : 10/24/2011
Last Update Date : 10/24/2011

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