Provider Demographics
NPI:1780961185
Name:DAVIS, GINA PERTL (CRNA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:PERTL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:KAY
Other - Last Name:PERTL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST STE 5.020
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6200
Practice Address - Fax:713-500-0648
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121449367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01095309OtherRAILROAD MEDICARE
TX8497UCOtherBLUE CROSS BLUE SHIELD
TX292246001Medicaid
TX292246002Medicaid
LA2327267Medicaid
TX8497UCOtherBLUE CROSS BLUE SHIELD