Provider Demographics
NPI:1962861948
Name:SANTIAGO-SOSA, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SANTIAGO-SOSA
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 1:709 WICKHAM DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-7458
Mailing Address - Country:US
Mailing Address - Phone:912-435-5564
Mailing Address - Fax:912-435-6310
Practice Address - Street 1:192 LINDQUIST RD, FT STEWART
Practice Address - Street 2:HAWKS CLINICS,
Practice Address - City:LIBERTY
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-5564
Practice Address - Fax:912-435-6310
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9375475163W00000X
PR002053163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse