Provider Demographics
NPI:1548817125
Name:DAVIS, ALVATINA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALVATINA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RED TOP LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6642
Mailing Address - Country:US
Mailing Address - Phone:386-569-7991
Mailing Address - Fax:386-263-8131
Practice Address - Street 1:14 RED TOP LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6642
Practice Address - Country:US
Practice Address - Phone:386-569-7991
Practice Address - Fax:386-263-8131
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5171265164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse