Provider Demographics
NPI:1841694718
Name:SAVAGE, JERYL DOUGLAS (ACNP)
Entity type:Individual
Prefix:
First Name:JERYL
Middle Name:DOUGLAS
Last Name:SAVAGE
Suffix:
Gender:
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13677 W MCDOWELL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2635
Mailing Address - Country:US
Mailing Address - Phone:623-536-4200
Mailing Address - Fax:623-935-0304
Practice Address - Street 1:13677 W MCDOWELL RD STE 201
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2635
Practice Address - Country:US
Practice Address - Phone:623-536-4200
Practice Address - Fax:623-935-0304
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-002038363L00000X
AZAP7365363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner