Provider Demographics
NPI:1285375196
Name:DAVIS, PATIENCE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 SE HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3204
Mailing Address - Country:US
Mailing Address - Phone:863-990-0090
Mailing Address - Fax:
Practice Address - Street 1:2400 HARBOR BLVD STE 7
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5038
Practice Address - Country:US
Practice Address - Phone:941-766-5099
Practice Address - Fax:941-764-0194
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11018288363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care