Provider Demographics
NPI:1861828998
Name:DAVIS, LINESHA SHAMARA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LINESHA
Middle Name:SHAMARA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-259-0926
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:2209 NORTH BLVD W
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8903
Practice Address - Country:US
Practice Address - Phone:863-679-8000
Practice Address - Fax:863-679-2694
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056390363AM0700X
FLPA9108584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical