Provider Demographics
NPI:1821552761
Name:DAVIS, TARYRSHA (APN)
Entity Type:Individual
Prefix:
First Name:TARYRSHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:TARYRSHA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:620 N RIVER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8951
Mailing Address - Country:US
Mailing Address - Phone:630-364-2484
Mailing Address - Fax:630-536-8511
Practice Address - Street 1:620 N RIVER RD STE 106
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8951
Practice Address - Country:US
Practice Address - Phone:630-364-2484
Practice Address - Fax:630-536-8511
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023614363L00000X
IL209.018789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner