NPI 1114708138 · live from the CMS NPI Registry
Rudolfo Santos Agustin, FNP-BC
Nurse Practitioner, Family in Suffolk, VA. National Provider Identifier 1114708138, active.
NPI record
| NPI | 1114708138 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 2800 Godwin Blvd, Suffolk, VA 23434 |
| Practice phone | 757-934-4815 |
| Mailing address | 4820 Templar Dr, Portsmouth, VA 23703 |
| Enumerated | October 6, 2023 |
| Last updated | October 6, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse, Emergency | 163WE0003X | 0001279793 (VA) |
| Nurse Practitioner, Family primary | 363LF0000X | 0024188387 (VA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.