Provider Demographics
NPI:1235384694
Name:DAVAULT, GEORGIA D (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:D
Last Name:DAVAULT
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 LOCHNESS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4928
Mailing Address - Country:US
Mailing Address - Phone:239-997-7019
Mailing Address - Fax:
Practice Address - Street 1:14271 METROPOLIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4302
Practice Address - Country:US
Practice Address - Phone:239-939-7777
Practice Address - Fax:239-936-0036
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1070882363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health