Rudolfo Santos Agustin Jr., FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Suffolk, VA
NPI 1114708138 · NPPES record last updated Oct 6, 2023
Key facts
- NPI
- 1114708138
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 0024188387 (VA)
- Practice address
- 2800 Godwin Blvd
Suffolk, VA 23434-8038 - Phone
- (757) 934-4815
- NPI assigned
- Oct 6, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0001279793 | VA | MD | Emergency Registered Nurse |
| 0024188387 | VA | MD | Family Nurse Practitioner |
Interoperability endpoints
- rudolfo.agustin.1@29402.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 0001279793 | VA | |
| Family Nurse Practitioner | 363LF0000X | 0024188387 | VA | Yes |
Addresses
Primary practice location
2800 Godwin Blvd
Suffolk, VA 23434-8038
Mailing address
4820 Templar Dr
Portsmouth, VA 23703-3934
Other providers in Suffolk, VA
- William Edward Adkins
- Advance Comprehensive Home Health Care LLC
- Advantage Rehab Inc
- Affinity Healthcare Group Franklin LLC
- James Aguiar
- Noor Ul Ain
- Akata Medical LLC
- Ahmed Al Dabbagh
- Noora Al Khalidi
- Johniece Marie Alagala
All providers in Suffolk, VA · Family Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.