Healthcare Provider Details

I. General information

NPI: 1871429167
Provider Name (Legal Business Name): MARISELA SANTIAGO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19220 NW 50TH CT
MIAMI GARDENS FL
33055-2039
US

IV. Provider business mailing address

19220 NW 50TH CT
MIAMI GARDENS FL
33055-2039
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-4915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: