Provider Demographics
NPI:1366792137
Name:NIVENS, ALICE ANITA (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:ANITA
Last Name:NIVENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 OLD OLIVE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:31308-4805
Mailing Address - Country:US
Mailing Address - Phone:912-898-4435
Mailing Address - Fax:913-443-9410
Practice Address - Street 1:1302 DRAYTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6913
Practice Address - Country:US
Practice Address - Phone:912-443-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN077978363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner