Provider Demographics
NPI:1265031736
Name:HAYNES, SAVANNAH (STUDENT)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PALM RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-6305
Mailing Address - Country:US
Mailing Address - Phone:772-486-6114
Mailing Address - Fax:
Practice Address - Street 1:6 PALM RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-6305
Practice Address - Country:US
Practice Address - Phone:772-486-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program