Provider Demographics
NPI:1922382472
Name:SPEARMAN, SAVANNAH MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MARIE
Last Name:SPEARMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9171
Mailing Address - Country:US
Mailing Address - Phone:843-797-5050
Mailing Address - Fax:843-797-3633
Practice Address - Street 1:2880 TRICOM ST
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-797-5050
Practice Address - Fax:843-797-3633
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17633363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1326287434OtherMEDICAID DME NPI
SCNP2168Medicaid
SC1225006760OtherGROUP NPI
SC57-0634057OtherGROUP TAX ID
SC20000499OtherSELECT HEALTH GROUP
SC1326287434OtherMEDICAID DME NPI
SC1701OtherMEDICARE GROUP
SCCD2877OtherMEDICARE RAILROAD GROUP
SC0422990001Medicare NSC