Provider Demographics
NPI:1477680593
Name:SANTIAGO, ANGELA K (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:K
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6420 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4203
Mailing Address - Country:US
Mailing Address - Phone:352-331-2332
Mailing Address - Fax:352-331-6515
Practice Address - Street 1:6420 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4203
Practice Address - Country:US
Practice Address - Phone:352-331-2332
Practice Address - Fax:352-331-6515
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9217962363LA2200X
FLRN9217962163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308900200Medicaid
FL308900200Medicaid