Provider Demographics
NPI:1528302726
Name:TOBAS, DAVON A (FNP)
Entity type:Individual
Prefix:
First Name:DAVON
Middle Name:A
Last Name:TOBAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 NW 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3818
Mailing Address - Country:US
Mailing Address - Phone:850-624-9760
Mailing Address - Fax:
Practice Address - Street 1:1501 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7512
Practice Address - Country:US
Practice Address - Phone:954-788-0739
Practice Address - Fax:954-788-7347
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9421653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily