Provider Demographics
NPI:1164188660
Name:SANTIAGO, JENNIFER (MSN, RN, ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MSN, RN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 JANKOWSKI CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2450
Mailing Address - Country:US
Mailing Address - Phone:908-405-9423
Mailing Address - Fax:
Practice Address - Street 1:1333 JANKOWSKI CT
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2450
Practice Address - Country:US
Practice Address - Phone:908-405-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01227000364SM0705X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical