Provider Demographics
NPI:1417348186
Name:SANTANA, RAPHAEL (FNP)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:
Last Name:SANTANA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HERITAGE FARMS DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6656
Mailing Address - Country:US
Mailing Address - Phone:830-513-5230
Mailing Address - Fax:
Practice Address - Street 1:161 HERITAGE FARMS DR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6656
Practice Address - Country:US
Practice Address - Phone:830-513-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily