Provider Demographics
NPI:1538549944
Name:DAVIS, LAURA ANNE (AGACNP, BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AGACNP, BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MCLAUCHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP, BC
Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:STE 4015
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6017
Mailing Address - Fax:904-450-6041
Practice Address - Street 1:800 PRUDENTIAL DR STE 1100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-338-6518
Practice Address - Fax:904-384-1005
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9348564363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166422AMedicaid
FL015011400Medicaid
FLIE714ZMedicare PIN
FLP01542103Medicare PIN