Provider Demographics
NPI:1477556785
Name:DAVINA, ELEANOR FRANCES (DO)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:FRANCES
Last Name:DAVINA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 LAKE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2364
Mailing Address - Country:US
Mailing Address - Phone:352-383-8222
Mailing Address - Fax:352-383-1420
Practice Address - Street 1:3619 LAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2364
Practice Address - Country:US
Practice Address - Phone:352-383-8222
Practice Address - Fax:352-383-1420
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593483343OtherTAX ID
FL57111YMedicare ID - Type Unspecified
FLG02637Medicare UPIN