Provider Demographics
NPI:1821744673
Name:HICKS, SAVANNAH GRACE (APRN)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:GRACE
Last Name:HICKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:GRACE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2680 N ORANGE AVE APT 1226
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4677
Mailing Address - Country:US
Mailing Address - Phone:321-507-0188
Mailing Address - Fax:
Practice Address - Street 1:62 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1115
Practice Address - Country:US
Practice Address - Phone:407-514-3668
Practice Address - Fax:321-843-2196
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9467016163W00000X
FLAPRN11032712367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse