Provider Demographics
NPI:1083881353
Name:SANTANA, JUAN CARLOS (ARNP)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:SANTANA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 SW 70TH ST APT 445
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3428
Mailing Address - Country:US
Mailing Address - Phone:305-733-2826
Mailing Address - Fax:
Practice Address - Street 1:1430 S DIXIE HWY STE 304
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3159
Practice Address - Country:US
Practice Address - Phone:888-696-4322
Practice Address - Fax:786-272-5719
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9214359363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001930400Medicaid
FL001930400Medicaid