Provider Demographics
NPI:1609475821
Name:NORMAN, DAVINA DEMERRITT (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DAVINA
Middle Name:DEMERRITT
Last Name:NORMAN
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 1:113 APRIL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9709
Mailing Address - Country:US
Mailing Address - Phone:704-917-8275
Mailing Address - Fax:
Practice Address - Street 1:188 OSCAR JUSTICE RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-8110
Practice Address - Country:US
Practice Address - Phone:828-286-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158841163W00000X
NC5014058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse