Provider Demographics
NPI:1659622744
Name:SANTIAGO, JENNIFER ELDER (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELDER
Last Name:SANTIAGO
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 540547
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-0547
Mailing Address - Country:US
Mailing Address - Phone:321-221-7447
Mailing Address - Fax:
Practice Address - Street 1:1790 HIGHWAY A1A STE 205
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-5440
Practice Address - Country:US
Practice Address - Phone:321-221-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner