Provider Demographics
NPI:1558910851
Name:DAVIDSON, SABRINA (FNP)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:ECRU
Mailing Address - State:MS
Mailing Address - Zip Code:38841-8471
Mailing Address - Country:US
Mailing Address - Phone:662-488-8799
Mailing Address - Fax:624-888-7296
Practice Address - Street 1:5482 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:ECRU
Practice Address - State:MS
Practice Address - Zip Code:38841-8471
Practice Address - Country:US
Practice Address - Phone:662-488-8799
Practice Address - Fax:662-488-8729
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903546363LF0000X
MSMCCL-JMNG9Q363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily