Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 338701 | FL |
N | 363LA2200X | Nurse Practitioner - Adult Health | 73965 | MA |
NPI | 1013966688 |
---|---|
Provider Name | Ms. Helene A Disantos |
First Address | Ormond Beach, FL 32174-1494 |
Second Address | Deland, FL 32724-5504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0346331 | (05) | MA |
338701 | FLORIDA ARNP LICENSE # (01) | FL |
73965 | RN/ARNP LICENSE # (01) | MA |
R93491 | (02) | FL |