Provider Demographics
NPI:1730377300
Name:DAVIS, CHANTINA DANYELL (PA-C)
Entity type:Individual
Prefix:
First Name:CHANTINA
Middle Name:DANYELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9838 OLD BAYMEADOWS RD # 276
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-730-5115
Mailing Address - Fax:904-828-5552
Practice Address - Street 1:9550 BAYMEADOWS RD STE 9
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0748
Practice Address - Country:US
Practice Address - Phone:904-730-5115
Practice Address - Fax:904-828-5552
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2021-05-04
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103211363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical