Provider Demographics
NPI:1598437485
Name:DAVIS, EMMA ALYSE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ALYSE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ALYSE
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2116 SE 16TH LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4123
Mailing Address - Country:US
Mailing Address - Phone:352-875-1357
Mailing Address - Fax:
Practice Address - Street 1:1500 SE 17TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4649
Practice Address - Country:US
Practice Address - Phone:352-351-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115091363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical