Provider Demographics
NPI:1285913772
Name:RODRIGUEZ SANTOS, GRACIELA ADRIANA (FNP)
Entity type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:ADRIANA
Last Name:RODRIGUEZ SANTOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6311 LONGFELLOW ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2665
Mailing Address - Country:US
Mailing Address - Phone:240-839-8238
Mailing Address - Fax:202-265-0927
Practice Address - Street 1:8630 FENTON ST STE 1204
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3808
Practice Address - Country:US
Practice Address - Phone:301-585-1250
Practice Address - Fax:301-585-6289
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCRN967237363LF0000X
VA0024173077363LF0000X
MDR156586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRN967237OtherSTATE LICENSE