Healthcare Provider Details

I. General information

NPI: 1679405930
Provider Name (Legal Business Name): ROIKIESHA TENNANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 TIBET AVE
SAVANNAH GA
31406-9028
US

IV. Provider business mailing address

73 HIGHLANDS BLVD
SAVANNAH GA
31407-4107
US

V. Phone/Fax

Practice location:
  • Phone: 912-777-8454
  • Fax:
Mailing address:
  • Phone: 706-831-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP298461
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: