Provider Demographics
NPI:1881606366
Name:DAVIS, JACKIE B (CNM)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:BLANKENSHIP
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1630 SE 18TH ST
Mailing Address - Street 2:BLDG 300
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5471
Mailing Address - Country:US
Mailing Address - Phone:352-620-2229
Mailing Address - Fax:352-620-8833
Practice Address - Street 1:1630 SE 18TH ST
Practice Address - Street 2:BLDG 300
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5471
Practice Address - Country:US
Practice Address - Phone:352-620-2229
Practice Address - Fax:352-620-8833
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1647842367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033850800Medicaid
S14614Medicare UPIN
Y2826WMedicare PIN