Healthcare Provider Details

I. General information

NPI: 1194858134
Provider Name (Legal Business Name): JENNIFER DELGADO-SANTIAGO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 STIRLING CENTER PL STE 1008
LAKE MARY FL
32746-4889
US

IV. Provider business mailing address

1704 PINE BAY DR
LAKE MARY FL
32746-6293
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-1212
  • Fax: 407-333-1213
Mailing address:
  • Phone: 407-373-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013744
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9192287
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: