Provider Demographics
NPI:1699492884
Name:DAVIS, KARINA (MSW)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 GWYN CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7006
Mailing Address - Country:US
Mailing Address - Phone:772-444-5013
Mailing Address - Fax:
Practice Address - Street 1:1048 GWYN CIR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7006
Practice Address - Country:US
Practice Address - Phone:772-444-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD120-505-97-666-0Medicaid