Provider Demographics
NPI:1194858134
Name:DELGADO-SANTIAGO, JENNIFER (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DELGADO-SANTIAGO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 PINE BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6293
Mailing Address - Country:US
Mailing Address - Phone:407-373-5093
Mailing Address - Fax:
Practice Address - Street 1:752 STIRLING CENTER PL STE 1008
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4889
Practice Address - Country:US
Practice Address - Phone:407-333-1212
Practice Address - Fax:407-333-1213
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013744363LF0000X
FLRN9192287163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid