Healthcare Provider Details

I. General information

NPI: 1699144436
Provider Name (Legal Business Name): DIANE SANTOPADRE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 103
ST AUGUSTINE FL
32080-3109
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 103
ST AUGUSTINE FL
32080-3109
US

V. Phone/Fax

Practice location:
  • Phone: 904-461-5330
  • Fax: 904-461-5334
Mailing address:
  • Phone: 904-461-5330
  • Fax: 904-461-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP2858672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: