MEDICARE: MS. MARISELA SANTIAGO APRN

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	363LF0000X	Family Nurse Practitioner	APRN11048653	FL

General Provider Information

NPI Number	:	1871429167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISELA SANTIAGO APRN

Provider Business Mailing Address
First Line	:	19220 NW 50TH CT
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19220 NW 50TH CT
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2039
Country	:	US
Telephone Number	:	786-202-4915
Fax Number	:

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

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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