Provider Demographics
NPI:1265572986
Name:DAVIS, TERESA (HS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 RESCUE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762
Mailing Address - Country:US
Mailing Address - Phone:727-535-1437
Mailing Address - Fax:727-535-4190
Practice Address - Street 1:15100 RESCUE WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762
Practice Address - Country:US
Practice Address - Phone:727-535-1437
Practice Address - Fax:727-535-4190
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider