Provider Demographics
NPI:1881188191
Name:SANTIAGO, JENNIFER MARIE (DNP, MSN, APRN, AGNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:DNP, MSN, APRN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-0250
Mailing Address - Country:US
Mailing Address - Phone:800-507-5040
Mailing Address - Fax:203-298-1051
Practice Address - Street 1:PO BOX 250
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-0250
Practice Address - Country:US
Practice Address - Phone:800-507-5040
Practice Address - Fax:203-298-1051
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7583363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health