MEDICARE: JACQUELYN CUNNIEN-DAVIS PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11033021	FL

General Provider Information

NPI Number	:	1982444055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN CUNNIEN-DAVIS PMHNP-BC

Provider Business Mailing Address
First Line	:	6124 S TAMIAMI TRL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-4029
Country	:	US
Telephone Number	:	941-925-6672
Fax Number	:	941-925-6680

Provider Business Practice Location Address
First Line	:	6124 S TAMIAMI TRL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-4029
Country	:	US
Telephone Number	:	941-925-6672
Fax Number	:	941-925-6680

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

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	02/04/2026

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