Healthcare Provider Details

I. General information

NPI: 1366997645
Provider Name (Legal Business Name): ANGELA SANTIAGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

IV. Provider business mailing address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

V. Phone/Fax

Practice location:
  • Phone: 352-694-4824
  • Fax: 352-694-4824
Mailing address:
  • Phone: 352-694-4824
  • Fax: 352-694-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN 9321956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: