Healthcare Provider Details

I. General information

NPI: 1396291571
Provider Name (Legal Business Name): DR. KIRENIA SANTIUSTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 SW 64TH AVE STE 101
DAVIE FL
33314-4400
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-434-1705
  • Fax: 954-218-5354
Mailing address:
  • Phone: 954-434-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9336030
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9336030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: