Healthcare Provider Details

I. General information

NPI: 1477680593
Provider Name (Legal Business Name): ANGELA K SANTIAGO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 NW 9TH BLVD
GAINESVILLE FL
32605-4203
US

IV. Provider business mailing address

6420 NW 9TH BLVD
GAINESVILLE FL
32605-4203
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-2332
  • Fax: 352-331-6515
Mailing address:
  • Phone: 352-331-2332
  • Fax: 352-331-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9217962
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9217962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: