Provider Demographics
NPI:1861036337
Name:OSPINA, SANTIAGO (ARNP)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:OSPINA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8707 SW 152ND AVE APT 328
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4127
Mailing Address - Country:US
Mailing Address - Phone:786-719-9215
Mailing Address - Fax:
Practice Address - Street 1:8707 SW 152ND AVE APT 328
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-4127
Practice Address - Country:US
Practice Address - Phone:786-719-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004644363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner