Provider Demographics
NPI:1720803562
Name:DAVIS, JAHQUAVIS J
Entity type:Individual
Prefix:
First Name:JAHQUAVIS
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 CASCADE BEND DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-6309
Mailing Address - Country:US
Mailing Address - Phone:941-894-9573
Mailing Address - Fax:
Practice Address - Street 1:343 CASCADE BEND DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-6309
Practice Address - Country:US
Practice Address - Phone:941-894-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No126800000XDental ProvidersDental Assistant