Provider Demographics
NPI:1407406903
Name:DAVIS, EDDIE II
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18625 SAN RIO CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3918
Mailing Address - Country:US
Mailing Address - Phone:813-505-3726
Mailing Address - Fax:
Practice Address - Street 1:18625 SAN RIO CIR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-3918
Practice Address - Country:US
Practice Address - Phone:813-505-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty