Provider Demographics
NPI:1982126553
Name:DAVIS, MARCIA CAMILLE
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:CAMILLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5136 GLEN ALAN CT N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8756
Mailing Address - Country:US
Mailing Address - Phone:904-403-8141
Mailing Address - Fax:
Practice Address - Street 1:5136 GLEN ALAN CT N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8756
Practice Address - Country:US
Practice Address - Phone:904-403-8141
Practice Address - Fax:904-403-8141
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239345376J00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No253Z00000XAgenciesIn Home Supportive Care