Provider Demographics
NPI:1497541999
Name:SANTALLA, JASMINE ALEXIS
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALEXIS
Last Name:SANTALLA
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 1:136 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4020
Mailing Address - Country:US
Mailing Address - Phone:609-903-1766
Mailing Address - Fax:
Practice Address - Street 1:13911 CARROLLWOOD VILLAGE RUN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2746
Practice Address - Country:US
Practice Address - Phone:352-518-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical