Provider Demographics
NPI:1194203471
Name:SANTAELLA, MARIA V
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:V
Last Name:SANTAELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4784 HICKORY STREAM LN
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-7914
Mailing Address - Country:US
Mailing Address - Phone:813-679-9469
Mailing Address - Fax:863-943-5201
Practice Address - Street 1:4784 HICKORY STREAM LN
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-7914
Practice Address - Country:US
Practice Address - Phone:813-679-9469
Practice Address - Fax:863-943-5201
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5177275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5177275OtherLPN