Provider Demographics
NPI:1659146306
Name:SANTANA, BIANCA
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 ESTATES CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7056
Mailing Address - Country:US
Mailing Address - Phone:561-512-6198
Mailing Address - Fax:
Practice Address - Street 1:4727 ESTATES CIR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470-7056
Practice Address - Country:US
Practice Address - Phone:561-512-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner