Provider Demographics
NPI:1265423438
Name:SANTOS, JANICE T (RN, MSN, CPNP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:T
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8907
Mailing Address - Country:US
Mailing Address - Phone:559-538-3070
Mailing Address - Fax:559-538-3071
Practice Address - Street 1:2497 HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-538-3070
Practice Address - Fax:559-538-3071
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95095882363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003654Medicaid
NC7003654Medicaid