Provider Demographics
NPI:1912176751
Name:DAVIS, DEBORAH LYNN (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ARNP-C
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Mailing Address - Street 1:4600 N HABANA AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7112
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:3554 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8402
Practice Address - Country:US
Practice Address - Phone:727-321-4846
Practice Address - Fax:727-321-3811
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2016-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9189441363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015027500Medicaid
FLAL754Medicare PIN