Provider Demographics
NPI:1790976330
Name:DAVIS, JENNIFER STARR (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:STARR
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:STARR
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2336 SE OCEAN BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3310
Mailing Address - Country:US
Mailing Address - Phone:772-220-3339
Mailing Address - Fax:772-286-2635
Practice Address - Street 1:2220 SE OCEAN BLVD STE 301
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3301
Practice Address - Country:US
Practice Address - Phone:772-220-3339
Practice Address - Fax:772-286-2635
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2024-07-27
Deactivation Date:2019-02-22
Deactivation Code:
Reactivation Date:2019-03-06
Provider Licenses
StateLicense IDTaxonomies
AZ4357363A00000X
FL9104207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY04VTOtherFLORIDA BLUE (BCBS OF FL)
FLP01165507OtherRR MEDICARE
FLY04VTOtherFLORIDA BLUE (BCBS OF FL)