Provider Demographics
NPI:1467962746
Name:DAVIS, SUCCURA MALICCA (FNP)
Entity type:Individual
Prefix:
First Name:SUCCURA
Middle Name:MALICCA
Last Name:DAVIS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W KERN AVE
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93250-1360
Mailing Address - Country:US
Mailing Address - Phone:661-792-3038
Mailing Address - Fax:661-792-6270
Practice Address - Street 1:217 W KERN AVE
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:CA
Practice Address - Zip Code:93250-1360
Practice Address - Country:US
Practice Address - Phone:661-792-3038
Practice Address - Fax:661-792-6270
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA769892163WG0000X
CA95008073363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily