Provider Demographics
NPI:1215097746
Name:DAVIS, ESTHER LOUISE (ADVANCED PRACTICE MI)
Entity type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE MI
Other - Prefix:MS
Other - First Name:ESTHER
Other - Middle Name:LOUISE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADVANCED PRACTICE MI
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6014
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:5153 N 9TH AVE STE 307
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5719
Practice Address - Country:US
Practice Address - Phone:850-416-6378
Practice Address - Fax:850-416-2278
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1051239367A00000X
FLAPRN11006773367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL569900125Medicaid
ALS77346Medicare UPIN