Healthcare Provider Details

I. General information

NPI: 1962313544
Provider Name (Legal Business Name): JAN ANDREE SANTIAGO-TORRES M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 S FLORIDA AVE
LAKELAND FL
33813-3327
US

IV. Provider business mailing address

1220 SOUTHERLY PARC LN APT 208
ORANGE CITY FL
32763-8101
US

V. Phone/Fax

Practice location:
  • Phone: 863-450-3067
  • Fax:
Mailing address:
  • Phone: 939-294-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: