Provider Demographics
NPI:1962980631
Name:SANTOS ALVES, PIETTRA (DNP,FNP)
Entity type:Individual
Prefix:
First Name:PIETTRA
Middle Name:
Last Name:SANTOS ALVES
Suffix:
Gender:F
Credentials:DNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8849 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6742
Mailing Address - Country:US
Mailing Address - Phone:727-863-7150
Mailing Address - Fax:
Practice Address - Street 1:8849 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6742
Practice Address - Country:US
Practice Address - Phone:727-863-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK105234207Q00000X, 363LF0000X
CT11239363LF0000X
FLAPRN11010445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1962980631Medicaid
OK1962980631OtherFAMILY PRACTICE