Provider Demographics
NPI:1578940490
Name:SANTIAGO, AMY D (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SHADOW LN
Mailing Address - Street 2:STE 240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4158
Mailing Address - Country:US
Mailing Address - Phone:702-733-2982
Mailing Address - Fax:702-733-3824
Practice Address - Street 1:4432 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7825
Practice Address - Country:US
Practice Address - Phone:702-733-2982
Practice Address - Fax:702-733-3824
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner