Provider Demographics
NPI:1073786539
Name:DAVIS, LYNN LENORA
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:LENORA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LENORA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:PO BOX 56764
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-6764
Mailing Address - Country:US
Mailing Address - Phone:904-708-4579
Mailing Address - Fax:
Practice Address - Street 1:11873 NOBLE FIR CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9119
Practice Address - Country:US
Practice Address - Phone:904-708-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 143515376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide