Healthcare Provider Details

I. General information

NPI: 1114595048
Provider Name (Legal Business Name): TARYN VICTORIA SANTIAGO C-AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARYN VICTORIA ARCARESE

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 1183
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

1400 E BOULDER ST STE 1183
COLORADO SPRINGS CO
80909-5533
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6999
  • Fax: 719-365-2837
Mailing address:
  • Phone: 719-365-6999
  • Fax: 719-365-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberANT.0000154
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: