Provider Demographics
NPI:1699187591
Name:DAVIS, MARY L (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2950 ALT US HWY 27 S STE B
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4912
Mailing Address - Country:US
Mailing Address - Phone:863-402-3429
Mailing Address - Fax:863-402-3275
Practice Address - Street 1:2950 ALT US HWY 27 S STE B
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4912
Practice Address - Country:US
Practice Address - Phone:863-402-3429
Practice Address - Fax:863-402-3275
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMD16083146L00000X
FLRN2835352163W00000X
FLAPRN2835352363L00000X, 363LC1500X, 363LG0600X
FLARNP2835352363LA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27376500Medicaid