Provider Demographics
NPI:1306337332
Name:SOLOMON, PHYLLIS EVON (FNP)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:EVON
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PHYLISS
Other - Middle Name:EVON
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1570 BRAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0855
Mailing Address - Country:US
Mailing Address - Phone:912-764-9196
Mailing Address - Fax:
Practice Address - Street 1:1570 BRAMPTON AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0855
Practice Address - Country:US
Practice Address - Phone:912-764-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN150971163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice