Healthcare Provider Details

I. General information

NPI: 1841413960
Provider Name (Legal Business Name): DENISE SANTOLI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 PENNINGTON DR SUITE C
BLUFFTON SC
29910-9041
US

IV. Provider business mailing address

48 PENNINGTON DR STE C
BLUFFTON SC
29910-9045
US

V. Phone/Fax

Practice location:
  • Phone: 843-757-5559
  • Fax: 843-757-5546
Mailing address:
  • Phone: 912-313-4625
  • Fax: 843-757-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17590
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: