Provider Demographics
NPI:1962786707
Name:SANTANA, SANDRA (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:7901 4TH ST N STE 6381
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:646-217-2120
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 6381
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:646-217-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1060335163W00000X, 363LP0808X
PARN738668163W00000X
MDR246375163W00000X, 363LP0808X
AZ253959163W00000X
NY695018163WA0400X
PASP023393363LP0808X
FL11011278363LP0808X
NYF403221363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)