Provider Demographics
NPI:1104282383
Name:DAVENPORT, ANGELA FAITH (PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:FAITH
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:FAITH
Other - Last Name:REDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14822 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-8590
Mailing Address - Country:US
Mailing Address - Phone:352-462-9484
Mailing Address - Fax:
Practice Address - Street 1:14822 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-8590
Practice Address - Country:US
Practice Address - Phone:352-462-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9335139163W00000X
FLAPRN9335139363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse