Healthcare Provider Details

I. General information

NPI: 1669071296
Provider Name (Legal Business Name): JESSICA MARTINS SANTOS LU DNP, FNP-C, ENP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 NJ-18
EAST BRUNSWICK NJ
08816
US

IV. Provider business mailing address

108 MORGAN ST
HICKSVILLE NY
11801-3850
US

V. Phone/Fax

Practice location:
  • Phone: 732-613-6168
  • Fax:
Mailing address:
  • Phone: 908-764-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01325100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01325100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: