Provider Demographics
NPI:1982478400
Name:SANTORO, NICOLE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:SANTORO
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 N 40TH ST STE E1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3357
Mailing Address - Country:US
Mailing Address - Phone:602-464-9576
Mailing Address - Fax:602-626-8901
Practice Address - Street 1:16620 N 40TH ST STE E1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3357
Practice Address - Country:US
Practice Address - Phone:602-464-9576
Practice Address - Fax:602-626-8901
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ304829363LP0808X
AZRN205514163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health