Provider Demographics
NPI:1407418957
Name:DAVIS, JEREMY L (APN)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HARRISON ST STE 212F
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6087
Mailing Address - Country:US
Mailing Address - Phone:201-484-8950
Mailing Address - Fax:
Practice Address - Street 1:50 HARRISON ST STE 212F
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6087
Practice Address - Country:US
Practice Address - Phone:201-484-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00932500363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care