Healthcare Provider Details

I. General information

NPI: 1902901523
Provider Name (Legal Business Name): ANTONIA LYNN SANTANGELO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7645 MARKET ST SUITE 210
YOUNGSTOWN OH
44512-6098
US

IV. Provider business mailing address

7629 MARKET ST SUITE 200
YOUNGSTOWN OH
44512-6075
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-4540
  • Fax:
Mailing address:
  • Phone: 330-965-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.07402-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: