MEDICARE: CARLIE SANTIAGO PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1558253708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIE SANTIAGO PA-C

Provider Business Mailing Address
First Line	:	PSC 411 BOX 1174
Second Line	:
City	:	APO
State	:	AE
Zip	:	09112-0012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 411 BOX 1174
Second Line	:
City	:	APO
State	:	AE
Zip	:	09112-0012
Country	:	US
Telephone Number	:	404-451-2158
Fax Number	:

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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Directions to “ CARLIE SANTIAGO PA-C” Practice Location

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