Provider Demographics
NPI:1801222781
Name:DAVIS, ELIZABETH ALICE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 NW 183RD ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4502
Mailing Address - Country:US
Mailing Address - Phone:305-454-9070
Mailing Address - Fax:305-705-3256
Practice Address - Street 1:99 NW 183RD ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4502
Practice Address - Country:US
Practice Address - Phone:305-454-9070
Practice Address - Fax:305-705-3256
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211665163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health