Provider Demographics
NPI:1396033841
Name:PALLAS SANTAGUIDA, JEAN MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:PALLAS SANTAGUIDA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:LONG KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33001-0698
Mailing Address - Country:US
Mailing Address - Phone:305-304-1552
Mailing Address - Fax:
Practice Address - Street 1:91500 OVERSEAS HWY
Practice Address - Street 2:MARINERS HOSPITAL
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070
Practice Address - Country:US
Practice Address - Phone:305-434-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2098562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health