Healthcare Provider Details

I. General information

NPI: 1992376065
Provider Name (Legal Business Name): ASHLEY SANTAMARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21944 TOWN PLACE DR
BOCA RATON FL
33433-3713
US

IV. Provider business mailing address

21944 TOWN PLACE DR
BOCA RATON FL
33433-3713
US

V. Phone/Fax

Practice location:
  • Phone: 347-738-1762
  • Fax:
Mailing address:
  • Phone: 347-738-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPA9113548
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: