Provider Demographics
NPI:1447405477
Name:DEGENNARO, NICOLE HOPE (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:HOPE
Last Name:DEGENNARO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4907
Mailing Address - Country:US
Mailing Address - Phone:912-303-0891
Mailing Address - Fax:912-303-0893
Practice Address - Street 1:720 E 71ST ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4907
Practice Address - Country:US
Practice Address - Phone:912-303-0891
Practice Address - Fax:912-303-0893
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011110363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical