Provider Demographics
NPI:1245392802
Name:SANTOS, MARIGOLD HARESCO (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIGOLD
Middle Name:HARESCO
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARIGOLD
Other - Middle Name:GARLAND
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:305 DAHOON HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7121
Mailing Address - Country:US
Mailing Address - Phone:386-274-0094
Mailing Address - Fax:
Practice Address - Street 1:305 DAHOON HOLLY DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7121
Practice Address - Country:US
Practice Address - Phone:386-274-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2963222163W00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO135895OtherRN