Provider Demographics
NPI:1275885303
Name:DAVIS, DEBORAH ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32004-0772
Mailing Address - Country:US
Mailing Address - Phone:904-610-7203
Mailing Address - Fax:
Practice Address - Street 1:10151 DEERWOOD PARK BLVD STE 200-250
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0589
Practice Address - Country:US
Practice Address - Phone:904-309-9996
Practice Address - Fax:855-632-8329
Is Sole Proprietor?:No
Enumeration Date:2012-10-13
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2124972363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007222600Medicaid
GA003128909AMedicaid
FLE5012YMedicare PIN