Provider Demographics
NPI:1497202287
Name:SANTANA, JASMYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JASMYN
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BROADWAY
Mailing Address - Street 2:APT 4K
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY
Practice Address - Street 2:APT 4K
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4882
Practice Address - Country:US
Practice Address - Phone:212-444-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY660278-1163W00000X
DEL10040762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse