Provider Demographics
NPI:1295032399
Name:DAVIS, BOBBIE ANN
Entity Type:Individual
Prefix:MS
First Name:BOBBIE
Middle Name:ANN
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 1:5340 LONG RD APT E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1122
Mailing Address - Country:US
Mailing Address - Phone:407-285-1249
Mailing Address - Fax:
Practice Address - Street 1:6826 GADWALL LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6064
Practice Address - Country:US
Practice Address - Phone:407-285-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239779251E00000X
FL017090100251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017090100Medicaid
FL693730696Medicaid
FL234231Medicaid