Provider Demographics
NPI:1972809416
Name:DAVIS, LISA (PA)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:708 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3914
Mailing Address - Country:US
Mailing Address - Phone:727-446-1097
Mailing Address - Fax:833-941-2542
Practice Address - Street 1:708 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3914
Practice Address - Country:US
Practice Address - Phone:727-446-1097
Practice Address - Fax:833-941-2542
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01100027863363AM0700X
FLPA9118515363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical