Individual
MADINA SANTIAGO JUCABAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
146 E HOSPITAL DR STE 140, WEST COLUMBIA, SC 29169-4800
(803) 791-2203
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 791-2203
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24397
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP7673
—
SC
Enumeration date
12/08/2020
Last updated
03/17/2025
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