Healthcare Provider Details

I. General information

NPI: 1306516836
Provider Name (Legal Business Name): JESSICA ALICEA-SANTIAGO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WABANAKI WAY
INDIAN ISLAND ME
04468-1252
US

IV. Provider business mailing address

23 WABANAKI WAY
INDIAN ISLAND ME
04468-1252
US

V. Phone/Fax

Practice location:
  • Phone: 207-817-7400
  • Fax: 207-817-7459
Mailing address:
  • Phone: 207-817-7400
  • Fax: 207-817-7459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211282
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: