Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 11011693 | FL |
NPI | 1073107587 |
---|---|
Provider Name | Shelby Davis |
First Address | New Smyrna Beach, FL 32168-8514 |
Second Address | Daytona Beach, FL 32117-5168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2021 |
Last Update Date | 24/02/2021 |