Healthcare Provider Details

I. General information

NPI: 1851822332
Provider Name (Legal Business Name): JORGE LUIS SANTOS ALBA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JORGE LUIS SANTOS ALBA APRN

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7649 W COLONIAL DR STE 115
ORLANDO FL
32818-7423
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 407-522-2080
  • Fax: 833-963-0115
Mailing address:
  • Phone: 844-630-0700
  • Fax: 877-374-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number16-808
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11021062
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11021062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: