MEDICARE: MR. NICHOLAS DANIEL SANTALUCIA LNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	PENDING	VA

General Provider Information

NPI Number	:	1255065488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS DANIEL SANTALUCIA LNP

Provider Business Mailing Address
First Line	:	3811 E WEYBURN RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-2037
Country	:	US
Telephone Number	:	804-519-9483
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 E PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2368
Country	:	US
Telephone Number	:	855-444-9838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	07/13/2022

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