Provider Demographics
NPI:1952640146
Name:DAVIS, ZACHARY T (MSN, APRN, CNP)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MSN, APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 NILES CORTLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1976
Mailing Address - Country:US
Mailing Address - Phone:330-372-0260
Mailing Address - Fax:330-372-0261
Practice Address - Street 1:349 NILES CORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1976
Practice Address - Country:US
Practice Address - Phone:330-372-0260
Practice Address - Fax:330-372-0261
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14275NP363L00000X
OHAPRN.CNP.14275363LF0000X
OHRN363464363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081456Medicaid