Provider Demographics
NPI:1639935588
Name:DAVIS, TRICIA LYNN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 PONFIELD RD E
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2599
Mailing Address - Country:US
Mailing Address - Phone:443-703-8815
Mailing Address - Fax:
Practice Address - Street 1:326 PONFIELD RD E
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2599
Practice Address - Country:US
Practice Address - Phone:443-703-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211936363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology