Healthcare Provider Details

I. General information

NPI: 1285387639
Provider Name (Legal Business Name): JENNIFER SANTOS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 COUNTRY CLUB RD
WINSTON SALEM NC
27104-3519
US

IV. Provider business mailing address

3766 BURBANK LN
WINSTON SALEM NC
27106-5079
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3632
  • Fax:
Mailing address:
  • Phone: 336-624-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015679
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: