MEDICARE: MRS. DONNA B DAVENPORT ARNP

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	ARNP1341262	FL

General Provider Information

NPI Number	:	1578701876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA B DAVENPORT ARNP

Provider Business Mailing Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	SUITE D-2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-676-2302
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	SUITE D-2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-676-2302
Fax Number	:

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

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	01/26/2009

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