Provider Demographics
NPI:1184313868
Name:TITUS-THOMAS, DAVIA OLYMPIA
Entity type:Individual
Prefix:
First Name:DAVIA
Middle Name:OLYMPIA
Last Name:TITUS-THOMAS
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 1:930 WEBER DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4633
Mailing Address - Country:US
Mailing Address - Phone:732-421-0973
Mailing Address - Fax:
Practice Address - Street 1:930 WEBER DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-4633
Practice Address - Country:US
Practice Address - Phone:732-421-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029303363LP0808X
NJ26NJ01470100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health