Provider Demographics
NPI:1992712434
Name:DAVIDSON, NITA A (FNP)
Entity type:Individual
Prefix:MS
First Name:NITA
Middle Name:A
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NITA
Other - Middle Name:ANN
Other - Last Name:FLANAGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:901-227-4068
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:8040 WOLF RIVER BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1775
Practice Address - Country:US
Practice Address - Phone:901-726-0200
Practice Address - Fax:901-278-3050
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12154363L00000X, 363LP2300X
TN125823363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner