Provider Demographics
NPI:1851822332
Name:SANTOS ALBA, JORGE LUIS (APRN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:SANTOS ALBA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:LUIS
Other - Last Name:SANTOS ALBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:7649 W COLONIAL DR STE 115
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7423
Mailing Address - Country:US
Mailing Address - Phone:407-522-2080
Mailing Address - Fax:833-963-0115
Practice Address - Street 1:7649 W COLONIAL DR STE 115
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7423
Practice Address - Country:US
Practice Address - Phone:407-522-2080
Practice Address - Fax:833-963-0115
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16-808246ZC0007X
FL11021062363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11021062OtherSTATE LICENSE
FLMS7446443OtherDEA