MEDICARE: GRETTEL SANTOS FERNANDEZ RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	9699014	FL

General Provider Information

NPI Number	:	1477498095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETTEL SANTOS FERNANDEZ RN

Provider Business Mailing Address
First Line	:	10700 CITY CENTER BLVD APT 3303
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4080
Country	:	US
Telephone Number	:	786-486-2815
Fax Number	:	786-486-2815

Provider Business Practice Location Address
First Line	:	10700 CITY CENTER BLVD APT 3303
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4080
Country	:	US
Telephone Number	:	786-486-2815
Fax Number	:	786-486-2815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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