Healthcare Provider Details

I. General information

NPI: 1447405477
Provider Name (Legal Business Name): NICOLE HOPE DEGENNARO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E 71ST ST
SAVANNAH GA
31405-4907
US

IV. Provider business mailing address

720 E 71ST ST
SAVANNAH GA
31405-4907
US

V. Phone/Fax

Practice location:
  • Phone: 912-303-0891
  • Fax: 912-303-0893
Mailing address:
  • Phone: 912-303-0891
  • Fax: 912-303-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number011110
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: