Provider Demographics
NPI:1659622744
Name:SANTIAGO, JENNIFER ELDER (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELDER
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E MERRITT ISLAND CSWY #107
Mailing Address - Street 2:PMB 324
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952
Mailing Address - Country:US
Mailing Address - Phone:321-260-2101
Mailing Address - Fax:
Practice Address - Street 1:284 S BREVARD AVE
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2797
Practice Address - Country:US
Practice Address - Phone:321-260-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner