Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Theodora Lacy Davis

Individual provider Nurse Practitioner · NPI 1730054271

Theodora Lacy Davis is a Nurse Practitioner in Erie, Pennsylvania. Qualified in 2025, 1 year ago. Licensed in Pennsylvania.

Years since qualifying
1
Licensed in
PA
In the registry since
2025
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Practice location Address checks out

120 E 2nd St Ste 400
Erie, PA 16507-1577
Phone: (814) 456-8980
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence SP034083 (PA)

Record details

NPI number1730054271
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 6, 2025
Last updated in NPPESOctober 6, 2025
Certification dateOctober 6, 2025
Mailing address808 Michigan Blvd, Erie, PA 16505-3810

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

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