Provider Demographics
NPI:1891358529
Name:GUTIERREZ SANTANA, ASHLEY NICOLLE (MD)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:NICOLLE
Last Name:GUTIERREZ SANTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HIGHWAY, U-114
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-305-9340
Mailing Address - Fax:865-305-9144
Practice Address - Street 1:1924 ALCOA HIGHWAY, U-114
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-305-9340
Practice Address - Fax:865-305-9144
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6123082OtherDRIVERS LICENCE