Healthcare Provider Details

I. General information

NPI: 1770094070
Provider Name (Legal Business Name): ODALIS ALTAGRACIA BAEZ SANTANA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3383 NW 7TH ST FL 2
MIAMI FL
33125-4164
US

IV. Provider business mailing address

4353 NW 77TH AVE FL 3
MIAMI FL
33166-6736
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-0333
  • Fax: 305-359-7546
Mailing address:
  • Phone: 305-204-0333
  • Fax: 305-359-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9428683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: