Provider Demographics
NPI:1437620341
Name:DAVIS, DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 COLLEGE POINTE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3245
Mailing Address - Country:US
Mailing Address - Phone:239-343-9100
Mailing Address - Fax:
Practice Address - Street 1:9131 COLLEGE POINTE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3245
Practice Address - Country:US
Practice Address - Phone:239-343-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-06-24
Deactivation Date:2020-08-06
Deactivation Code:
Reactivation Date:2020-08-25
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily