Healthcare Provider Details

I. General information

NPI: 1164188660
Provider Name (Legal Business Name): JENNIFER SANTIAGO MSN, RN, ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 JANKOWSKI CT
SOUTH PLAINFIELD NJ
07080-2450
US

IV. Provider business mailing address

1333 JANKOWSKI CT
SOUTH PLAINFIELD NJ
07080-2450
US

V. Phone/Fax

Practice location:
  • Phone: 908-405-9423
  • Fax:
Mailing address:
  • Phone: 908-405-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number26NJ01227000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ01227000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: