Provider Demographics
NPI:1417983248
Name:SANTOS, EDEL (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:EDEL
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 SW 72ND AVE APT 220W
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7617
Mailing Address - Country:US
Mailing Address - Phone:786-287-6537
Mailing Address - Fax:
Practice Address - Street 1:8101 SW 72ND AVE APT 220W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7617
Practice Address - Country:US
Practice Address - Phone:786-287-6537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2018-01-27
Deactivation Date:2018-01-21
Deactivation Code:
Reactivation Date:2018-01-26
Provider Licenses
StateLicense IDTaxonomies
FLARNP9299615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764528700Medicaid