Provider Demographics
NPI:1477380871
Name:POLK, SAVANNAH A (NP)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:A
Last Name:POLK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:A
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4326
Mailing Address - Country:US
Mailing Address - Phone:225-246-6050
Mailing Address - Fax:
Practice Address - Street 1:2516 BROADMOOR BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2988
Practice Address - Country:US
Practice Address - Phone:318-387-9420
Practice Address - Fax:318-323-8216
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA212956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily