Provider Demographics
NPI:1013387430
Name:SAVONA, LIANA M (PA)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:M
Last Name:SAVONA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:M
Other - Last Name:JURGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1200 EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7631
Mailing Address - Country:US
Mailing Address - Phone:732-660-6200
Mailing Address - Fax:
Practice Address - Street 1:1200 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7631
Practice Address - Country:US
Practice Address - Phone:732-660-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00376800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant