Individual provider · Type 1 NPI

Ellen Davis

Surgical Physician Assistant · Lakeland, FL

NPI number 1194384362 Active

Practice location

130 Pablo St
Lakeland, FL 33803-3818

Call (863) 284-5906 Map

Fax (863) 284-5149

Mailing address

1324 Lakeland Hills Blvd, Managed Care Dept
Lakeland, FL 33805-4543

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA9112245 (FL)
Physician Assistant 363A00000XNone listed

Surgical Physician Assistant: Definition to come...

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About NPI 1194384362

Ellen Davis's National Provider Identifier is 1194384362, issued on Jun 11, 2019. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Lakeland, FL. The record was last updated on Nov 13, 2019.