Provider Demographics
NPI:1053077834
Name:DAVIS, JAQUITA OLIVIA
Entity Type:Individual
Prefix:
First Name:JAQUITA
Middle Name:OLIVIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-1043
Mailing Address - Country:US
Mailing Address - Phone:772-410-7307
Mailing Address - Fax:
Practice Address - Street 1:4675 48TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-1043
Practice Address - Country:US
Practice Address - Phone:772-410-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion