Healthcare Provider Details

I. General information

NPI: 1730672650
Provider Name (Legal Business Name): AIDA M PEREZ SANTAMARIA MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AIDA PEREZ SANTAMARIA RN

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 W 56TH TER UNIT 410
HIALEAH FL
33012-2006
US

IV. Provider business mailing address

1748 W 56TH TER UNIT 410
HIALEAH FL
33012-2006
US

V. Phone/Fax

Practice location:
  • Phone: 786-319-8826
  • Fax:
Mailing address:
  • Phone: 786-319-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9285606
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9285606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: