Basic Information
| Provider Information | |||||||||
| NPI: | 1497303028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE SANTIAGO | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | DIANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10515 W SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238326530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10515 W SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802095629 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2019 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 226871 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.