Provider Demographics
NPI:1124208558
Name:SANTIAGO, LISA (APRN, BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 E MICHIGAN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2700
Mailing Address - Country:US
Mailing Address - Phone:407-412-5567
Mailing Address - Fax:
Practice Address - Street 1:5555 E MICHIGAN ST STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2700
Practice Address - Country:US
Practice Address - Phone:407-412-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3457363LA2200X
FLAPRN1103226363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health