Provider Demographics
NPI:1124582986
Name:SANTANA, LYNNETTE MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:MICHELE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:8409 SW 80TH ST STE 16
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9117
Practice Address - Country:US
Practice Address - Phone:352-414-1922
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR021204208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice