Provider Demographics
NPI:1023692316
Name:DESANTIS, SAVANNA JOY (CRNP)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:JOY
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7867 HIGHWAY 137
Mailing Address - Street 2:
Mailing Address - City:VALLEY HEAD
Mailing Address - State:AL
Mailing Address - Zip Code:35989-4033
Mailing Address - Country:US
Mailing Address - Phone:256-516-0779
Mailing Address - Fax:
Practice Address - Street 1:504 MCCURDY AVE S
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5254
Practice Address - Country:US
Practice Address - Phone:256-638-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1146468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1146468OtherALABAMA BOARD OF NURSING