Provider Demographics
NPI:1689421802
Name:DAVIS, CATHERINE LYNE (MS FNP APRN-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LYNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS FNP APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 BEAN LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4350
Mailing Address - Country:US
Mailing Address - Phone:321-720-7161
Mailing Address - Fax:
Practice Address - Street 1:718 BEAN LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4350
Practice Address - Country:US
Practice Address - Phone:321-720-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily