Provider Demographics
NPI:1053473694
Name:DAVIS, CEILY TRACEY (PNP)
Entity Type:Individual
Prefix:MRS
First Name:CEILY
Middle Name:TRACEY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 WESTERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-2195
Mailing Address - Country:US
Mailing Address - Phone:916-206-3281
Mailing Address - Fax:
Practice Address - Street 1:7275 E SOUTHGATE DR STE 306
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2631
Practice Address - Country:US
Practice Address - Phone:916-422-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16863363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics