Provider Demographics
NPI:1093880387
Name:SANTOS, MARIE LUDNA (MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:MARIE LUDNA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4607
Mailing Address - Country:US
Mailing Address - Phone:305-246-5101
Mailing Address - Fax:305-246-5103
Practice Address - Street 1:131 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4607
Practice Address - Country:US
Practice Address - Phone:305-246-5101
Practice Address - Fax:305-246-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2575492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2575492OtherSTATE LICENSE
E4392Medicare ID - Type Unspecified
P11247Medicare UPIN