Provider Demographics
NPI:1295889368
Name:SANTANA SANTANA, HEIDI (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SANTANA SANTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9836 LOBLOLLY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-3606
Mailing Address - Country:US
Mailing Address - Phone:787-410-8611
Mailing Address - Fax:
Practice Address - Street 1:5564 E GRANT ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1666
Practice Address - Country:US
Practice Address - Phone:321-235-6230
Practice Address - Fax:321-235-6246
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014651208D00000X
FLACN1071208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBS8761101OtherDEA