Provider Demographics
NPI:1760717771
Name:DAVIS, PRISCILLA K (APN-C)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HOPE RD
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1277
Mailing Address - Country:US
Mailing Address - Phone:732-571-1000
Mailing Address - Fax:732-571-1156
Practice Address - Street 1:615 HOPE RD
Practice Address - Street 2:BUILDING 5
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1277
Practice Address - Country:US
Practice Address - Phone:732-571-1000
Practice Address - Fax:732-571-1156
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00231300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily