Provider Demographics
NPI:1396291571
Name:SANTIUSTE, KIRENIA
Entity type:Individual
Prefix:DR
First Name:KIRENIA
Middle Name:
Last Name:SANTIUSTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:
Practice Address - Street 1:4780 SW 64TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4400
Practice Address - Country:US
Practice Address - Phone:954-434-1705
Practice Address - Fax:954-218-5354
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9336030363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIW446ZMedicare PIN