Basic Information
| Provider Information | |||||||||
| NPI: | 1730730326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON DAVIS | ||||||||
| FirstName: | SHAREEFAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | DNP, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 E DIXIE AVE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347486350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524313940 | ||||||||
| FaxNumber: | 3524313173 | ||||||||
| Practice Location | |||||||||
| Address1: | 2753 CITRUS TOWER BLVD | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347116699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524313940 | ||||||||
| FaxNumber: | 3524313173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2019 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | APRN11005230 | FL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 11005230 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.