Provider Demographics
NPI:1720178668
Name:SANTIAGO, CARMENCITA C (BSN, RN, OCN, CRNI)
Entity Type:Individual
Prefix:
First Name:CARMENCITA
Middle Name:C
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:BSN, RN, OCN, CRNI
Other - Prefix:MRS
Other - First Name:CARMENCITA
Other - Middle Name:F
Other - Last Name:CAPIRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1220 CHRIS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3344
Mailing Address - Country:US
Mailing Address - Phone:404-851-8906
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD NE
Practice Address - Street 2:NORTHSIDE HOSPITAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-8906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN043197163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy