Provider Demographics
NPI:1295793461
Name:SAN EMETERIO, ELENA MARTHA (ARNP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:MARTHA
Last Name:SAN EMETERIO
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 1:3805 W 20TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4532
Mailing Address - Country:US
Mailing Address - Phone:305-557-2277
Mailing Address - Fax:305-557-2278
Practice Address - Street 1:3805 W 20TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4532
Practice Address - Country:US
Practice Address - Phone:305-557-2277
Practice Address - Fax:305-557-2278
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP487942363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009883800Medicaid
FL009883800Medicaid