Individual
ELLEN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 PABLO ST, LAKELAND, FL 33803-3818
(863) 284-5906
(863) 284-5149
Mailing address
1324 LAKELAND HILLS BLVD, MANAGED CARE DEPT, LAKELAND, FL 33805-4543
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA9112245
FL
Other
Enumeration date
06/11/2019
Last updated
11/13/2019
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