Provider Demographics
NPI:1063668630
Name:SANTOS, AMY MARIE (CCRN, MSN, ACNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:CCRN, MSN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7043 CAMINO DEGRAZIA
Mailing Address - Street 2:#200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-7812
Mailing Address - Country:US
Mailing Address - Phone:240-626-3702
Mailing Address - Fax:
Practice Address - Street 1:4077 FIFTH AVE
Practice Address - Street 2:TRAUMA SERVICES, MER62
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-260-7285
Practice Address - Fax:619-298-3704
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17951363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care