Provider Demographics
NPI:1740263706
Name:SANTANA, NANCY D (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:BLDG. B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-1000
Mailing Address - Fax:602-906-2789
Practice Address - Street 1:1840 S STAPLEY DR
Practice Address - Street 2:STE. 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6681
Practice Address - Country:US
Practice Address - Phone:480-464-8500
Practice Address - Fax:480-464-6966
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07901000207Q00000X
AZ35559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ143184Medicaid
AZ143184Medicaid
AZZ112322Medicare PIN