Provider Demographics
NPI:1669732624
Name:DAVIS, ELIZABETH E (CNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214F DIAMOND HEIGHTS BLVD # 3422
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2175
Mailing Address - Country:US
Mailing Address - Phone:415-360-3348
Mailing Address - Fax:931-208-3369
Practice Address - Street 1:485 BLACKLICK RD
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-9725
Practice Address - Country:US
Practice Address - Phone:740-504-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026902363LF0000X, 363LP0808X
OHCOA.13011-NP363LF0000X
MI4704312027363LF0000X
AZAP7391363LF0000X
IL209.033023363LP0808X
VA0024194388363LP0808X
DEL8-0010887363LP0808X
WV123875363LP0808X
OHAPRN.CNP.13011363LP0808X
NVAPRN001646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0136163Medicaid
OH0136163Medicaid
OHH247470OtherINDIVIDUAL MEDICARE PTAN