Provider Demographics
NPI:1780431007
Name:DAVIS, NICHOLAS (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N LITCHFIELD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1215
Mailing Address - Country:US
Mailing Address - Phone:602-249-8577
Mailing Address - Fax:
Practice Address - Street 1:1325 N LITCHFIELD RD STE 130
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1215
Practice Address - Country:US
Practice Address - Phone:602-249-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262759363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care