Healthcare Provider Details

I. General information

NPI: 1093287583
Provider Name (Legal Business Name): JORDAN DAVIS SANTALOCI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900A CENTREPARK DR
ASHEVILLE NC
28805-1274
US

IV. Provider business mailing address

PO BOX 25804
WINSTON SALEM NC
27114-5804
US

V. Phone/Fax

Practice location:
  • Phone: 828-767-1643
  • Fax: 828-676-1075
Mailing address:
  • Phone: 364-448-9100
  • Fax: 336-448-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: