Provider Demographics
NPI:1639698434
Name:CARTY-SANTIAGO, GAYNEL CHARMAINE (RN)
Entity Type:Individual
Prefix:
First Name:GAYNEL
Middle Name:CHARMAINE
Last Name:CARTY-SANTIAGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 POLO LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6196
Mailing Address - Country:US
Mailing Address - Phone:646-992-7125
Mailing Address - Fax:
Practice Address - Street 1:1839 POLO LAKE DR E
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6196
Practice Address - Country:US
Practice Address - Phone:646-992-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9464587163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty