Healthcare Provider Details

I. General information

NPI: 1366033854
Provider Name (Legal Business Name): SANTINA ARNOLD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANTINA CAPITA RN

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

3 AUDUBON PLAZA DR STE 340
LOUISVILLE KY
40217-1319
US

V. Phone/Fax

Practice location:
  • Phone: 502-634-6767
  • Fax: 502-634-6775
Mailing address:
  • Phone: 502-634-6767
  • Fax: 502-634-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015892
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: