Provider Demographics
NPI:1912470196
Name:DAVIS, ALYSSA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E MILAM ST
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-2359
Mailing Address - Country:US
Mailing Address - Phone:254-562-2500
Mailing Address - Fax:
Practice Address - Street 1:2703 FOREST RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-3377
Practice Address - Country:US
Practice Address - Phone:352-606-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036955363L00000X
FLAPRN11025334363L00000X
WVAPRN86867FNP-BC363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner