Healthcare Provider Details

I. General information

NPI: 1861315244
Provider Name (Legal Business Name): SANTOS PREMIER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 RAVEN HILL RD
SUFFOLK VA
23434-3053
US

IV. Provider business mailing address

8401 MAYLAND DR STE S
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 757-792-7740
  • Fax:
Mailing address:
  • Phone: 757-792-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA CARMOUCHE
Title or Position: OWNER
Credential: FNP-C, PMHNP-BC
Phone: 757-792-7740