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NPI Code Detail

MEDICARE: EMILY JORDAN SANTOLLA P.A.

MEDICARE: EMILY JORDAN SANTOLLA P.A.
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
1363AM0700XMedical Physician AssistantVA

General Provider Information

NPI Number : 1306695689
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY JORDAN SANTOLLA P.A.
Provider Business Mailing Address
First Line : 2000 HEALTH PARK DR FL HP2
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-4692
Country : US
Telephone Number : 615-373-7600
Fax Number : 866-346-1426
Provider Business Practice Location Address
First Line : 10 HICKOK ST STE 101
Second Line :
City : CHRISTIANSBURG
State : VA
Zip : 24073-3569
Country : US
Telephone Number : 540-381-1882
Fax Number : 540-382-1866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2024
Last Update Date : 05/17/2024

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