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General NPI Number Information
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NPI Number | 1992401541
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Entity Type | Individual
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Provider Name | SAMANTHA JO IVY APRN
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 80 ENOCH BLVD
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City | SAVANNAH
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State | TN
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Zip | 38372-2231
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Country | US
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Telephone | 731-926-9600
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Fax | 731-925-8349
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Provider Business Mailing Address
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Address Line | 80 ENOCH BLVD
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City | SAVANNAH
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State | TN
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Zip | 38372-2231
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Country | US
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Telephone | 731-926-9600
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Fax | 731-925-8349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 33365
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License Number State | TN
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