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Deactivated NPI 1053568568 Deactivated / Inactive NPI Female Practitioner

Renee Davis

Licensed Practical Nurse • Mastic, NY

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Renee Davis has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 26, 2008
NPI Deactivation Date May 22, 2025
Total Practice Duration ~17 Years of Practice (2008 – 2025)

Professional Overview & Biography Verified Profile Summary

Renee Davis was a registered Licensed Practical Nurse practicing in Mastic, NY. Throughout an active medical career spanning 17 years, Renee Davis provided care at the practice location at 168 SOUTHAVEN AVE until profile deactivation on 2025-05-22.

Practice Location & Contact Primary Location

Practice Address

168 Southaven Ave

Mastic, NY 119504011

Telephone 6317726762

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Mastic, NY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 8.0 Yrs
Regional Practice Density
62 Specialists

Practicing in Mastic, NY (23738 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License NY 257593

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
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NPI Profile Deactivated May 22, 2025

Record deactivated on May 22, 2025

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Updated Practice Location September 25, 2020

Registered at 7825 ANGELE LN APT 1427, CHARLOTTE, NC 282623655 (Tel: 6317726762)

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Updated Business Mailing Address September 25, 2020

Registered at 7825 ANGELE LN APT 1427, CHARLOTTE, NC 282623655 (Tel: 6317726762)

NPI Profile Active September 17, 2010

NPI status registered as active in NPPES database

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Updated Practice Location September 17, 2010

Registered at 168 SOUTHAVEN AVE, MASTIC, NY 119504011 (Tel: 6317726762)

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Updated Business Mailing Address September 17, 2010

Registered at 168 SOUTHAVEN AVE, MASTIC, NY 119504011 (Tel: 6317726762)

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Provider Name / Credentials Updated September 17, 2010

Recorded as RENEE DAVIS

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 17, 2010

Licensed Practical Nurse (License #257593 in NY)

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Initial NPI Registration & Enumeration August 26, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1053568568
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 26, 2008
Last Update: September 17, 2010
Deactivation Date: May 22, 2025

Mailing Address

168 Southaven Ave

Mastic, NY 119504011

Phone: 6317726762

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.