Provider Demographics
NPI:1699423012
Name:SANTIAGO, LUIS EMILIO (ARNP, FNP-C)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:EMILIO
Last Name:SANTIAGO
Suffix:
Gender:
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:
Practice Address - Street 1:200 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2582
Practice Address - Country:US
Practice Address - Phone:352-432-8989
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018683363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily