Provider Demographics
NPI:1184405060
Name:SANTOS, RAQUEL LEILANI (ARNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LEILANI
Last Name:SANTOS
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 WEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2060
Mailing Address - Country:US
Mailing Address - Phone:787-602-4792
Mailing Address - Fax:
Practice Address - Street 1:16332 CORTEZ BLVD STE F
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8980
Practice Address - Country:US
Practice Address - Phone:813-999-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029042363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health