MEDICARE: LISA SANTIAGO APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP3457	AZ
2	363LA2200X	Adult Health Nurse Practitioner	APRN1103226	FL

General Provider Information

NPI Number	:	1124208558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SANTIAGO APRN, BC

Provider Business Mailing Address
First Line	:	5555 E MICHIGAN ST STE 104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2700
Country	:	US
Telephone Number	:	407-412-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 E MICHIGAN ST STE 104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2700
Country	:	US
Telephone Number	:	407-412-5567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	08/12/2024

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