Provider Demographics
NPI:1366036543
Name:SANTIAGO, ANNA ROSA ELIA (MS)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:ROSA ELIA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 BURNT MILL RD APT 1235
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9129
Mailing Address - Country:US
Mailing Address - Phone:904-580-0282
Mailing Address - Fax:
Practice Address - Street 1:2700 WESTHALL LN STE 207
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7478
Practice Address - Country:US
Practice Address - Phone:904-370-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health