Provider Demographics
NPI:1881371557
Name:SANTAMARIA, IRMA LETICIA (FNP-C)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:LETICIA
Last Name:SANTAMARIA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:LETICIA
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 4500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2171
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:5601 W EUGIE AVE STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1258
Practice Address - Country:US
Practice Address - Phone:602-633-3833
Practice Address - Fax:602-633-3834
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN155417163W00000X
AZ293865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse