Provider Demographics
NPI:1518338391
Name:SANTAMARIA, MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SANTAMARIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 E VENICE AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9084
Mailing Address - Country:US
Mailing Address - Phone:941-584-6272
Mailing Address - Fax:941-584-6279
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:SUITE A10
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4608
Practice Address - Country:US
Practice Address - Phone:954-351-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108963363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical