MEDICARE: GLENDA L SANTOS AGPCNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	308318	NY

General Provider Information

NPI Number	:	1932627247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA L SANTOS AGPCNP-BC

Provider Business Mailing Address
First Line	:	10420 QUEENS BLVD APT 17G
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3610
Country	:	US
Telephone Number	:	347-276-8755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1283 YORK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11375
Country	:	US
Telephone Number	:	646-697-1700
Fax Number	:

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

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	07/14/2023

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