Provider Demographics
NPI:1962269274
Name:PENNINGTON, SAVANNAH BROOKE (FNP)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:BROOKE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 VALEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1740
Mailing Address - Country:US
Mailing Address - Phone:304-539-0921
Mailing Address - Fax:
Practice Address - Street 1:36440 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1330
Practice Address - Country:US
Practice Address - Phone:727-786-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily