Provider Demographics
NPI:1962867333
Name:SANTIESTEBAN BATISTA, ROBERTO CAMILO (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CAMILO
Last Name:SANTIESTEBAN BATISTA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 SW 32ND AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6957
Mailing Address - Country:US
Mailing Address - Phone:754-281-9947
Mailing Address - Fax:
Practice Address - Street 1:4701 SW 32ND AVE APT 4
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6957
Practice Address - Country:US
Practice Address - Phone:754-281-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty