Healthcare Provider Details

I. General information

NPI: 1346971066
Provider Name (Legal Business Name): SAVANNAH NICOLE TAYLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAVANNAH CARPENTER

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LLANFAIR AVE
CINCINNATI OH
45224-2972
US

IV. Provider business mailing address

1701 LLANFAIR AVE
CINCINNATI OH
45224-2972
US

V. Phone/Fax

Practice location:
  • Phone: 772-795-9608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007963RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: