Provider Demographics
NPI:1477785038
Name:DAVIS, NICOLE ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11163 LA QUINTA PL STE A200
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5257
Mailing Address - Country:US
Mailing Address - Phone:915-320-3854
Mailing Address - Fax:915-320-3856
Practice Address - Street 1:11163 LA QUINTA PL STE A200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-320-3854
Practice Address - Fax:915-320-3856
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA182147363LF0000X
TX685448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily