Provider Demographics
NPI:1295958148
Name:DAVIS, SHANI VANN (ANP-BC, CDE)
Entity type:Individual
Prefix:MRS
First Name:SHANI
Middle Name:VANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ANP-BC, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15511 N FLORIDA AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1263
Mailing Address - Country:US
Mailing Address - Phone:813-936-2609
Mailing Address - Fax:813-252-4452
Practice Address - Street 1:15511 N FLORIDA AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1263
Practice Address - Country:US
Practice Address - Phone:813-936-2609
Practice Address - Fax:813-252-4452
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3343442163WM0705X
FL3343442363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018412700Medicaid
FL018412700Medicaid
FLIQ399ZMedicare PIN