Healthcare Provider Details

I. General information

NPI: 1811616600
Provider Name (Legal Business Name): PABLO SANTANA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PIERCE ST # A2
PLAINVILLE CT
06062-2280
US

IV. Provider business mailing address

51 PIERCE ST # A2
PLAINVILLE CT
06062-2280
US

V. Phone/Fax

Practice location:
  • Phone: 860-517-9717
  • Fax:
Mailing address:
  • Phone: 860-517-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number181698
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2381446
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number017717
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: