Provider Demographics
NPI:1881763811
Name:PURVIS, STACEY ANN HODGE (FNP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN HODGE
Last Name:PURVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5313 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4800
Mailing Address - Country:US
Mailing Address - Phone:912-819-8407
Mailing Address - Fax:
Practice Address - Street 1:5313 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4800
Practice Address - Country:US
Practice Address - Phone:912-819-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00831872BMedicaid
GARN117924OtherGA LICENSE
GARN117924OtherGA LICENSE