Provider Demographics
NPI:1376301275
Name:SANTOS, NICOLE MARIE (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8899 UNIVERSITY CENTER LN STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1039
Mailing Address - Country:US
Mailing Address - Phone:858-249-4070
Mailing Address - Fax:858-249-4071
Practice Address - Street 1:9984 SCRIPPS RANCH BLVD UNIT 960
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1825
Practice Address - Country:US
Practice Address - Phone:619-880-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1685358163W00000X
CA95292032163W00000X
CO1000855363L00000X
CA95035252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse