Healthcare Provider Details

I. General information

NPI: 1922696418
Provider Name (Legal Business Name): VICTORIA ALEJANDRA SANTANA APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 01/27/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 SE MAIN ST
SIMPSONVILLE SC
29681-3218
US

IV. Provider business mailing address

608 SWEET WILLIAM WAY
FOUNTAIN INN SC
29644-3515
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-6112
  • Fax:
Mailing address:
  • Phone: 864-505-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24616
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number212568
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: