Provider Demographics
NPI:1336672765
Name:SANTOS, ANTHONY JAMES (RN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:SANTOS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:JAMES
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:201 N WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3209
Mailing Address - Country:US
Mailing Address - Phone:210-219-0916
Mailing Address - Fax:
Practice Address - Street 1:201 N WILLOW WAY
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3209
Practice Address - Country:US
Practice Address - Phone:210-219-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX895219163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine