Provider Demographics
NPI:1871037556
Name:SANTOS, MAGDALENA (NP-C)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BROAD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-1831
Mailing Address - Country:US
Mailing Address - Phone:423-493-5240
Mailing Address - Fax:423-593-5241
Practice Address - Street 1:1700 BROAD ST STE 140
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1831
Practice Address - Country:US
Practice Address - Phone:423-493-5240
Practice Address - Fax:423-593-5241
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily