Provider Demographics
NPI:1386134237
Name:SANTOS-KOLP, ROSANGELA (LPN)
Entity type:Individual
Prefix:
First Name:ROSANGELA
Middle Name:
Last Name:SANTOS-KOLP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4178 GATOR TRACE VILLAS CIR APT B
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5279
Mailing Address - Country:US
Mailing Address - Phone:772-971-8830
Mailing Address - Fax:
Practice Address - Street 1:4178 GATOR TRACE VILLAS CIR APT B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5279
Practice Address - Country:US
Practice Address - Phone:772-971-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5203542164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse