Provider Demographics
NPI:1740389683
Name:SANTOO-VAZQUEZ, CHANDROUTIE DAISY (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHANDROUTIE
Middle Name:DAISY
Last Name:SANTOO-VAZQUEZ
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3749
Mailing Address - Country:US
Mailing Address - Phone:772-485-9649
Mailing Address - Fax:954-921-1902
Practice Address - Street 1:3900 UNIVERSITY BLVD S STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4331
Practice Address - Country:US
Practice Address - Phone:904-760-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3037962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105831900Medicaid