Provider Demographics
NPI:1881196798
Name:SANTANA, JENNIFER MARCH (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARCH
Last Name:SANTANA
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 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-0703
Mailing Address - Fax:813-974-2812
Practice Address - Street 1:3603 W ROYAL PALM CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8353
Practice Address - Country:US
Practice Address - Phone:813-789-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9243325363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHMN9AOtherBLUE CROSS BLUE SHIELD
FLJJ439ZOtherMEDICARE
FL024766300Medicaid