Provider Demographics
NPI:1457024333
Name:SANTANA, MARIEANNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIEANNA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 FRUITWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2502
Mailing Address - Country:US
Mailing Address - Phone:631-355-5336
Mailing Address - Fax:
Practice Address - Street 1:264 FRUITWOOD LN
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2502
Practice Address - Country:US
Practice Address - Phone:631-355-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily