Provider Demographics
NPI:1316966708
Name:SANTIAGO-MARTIR, IVETTE (MD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:SANTIAGO-MARTIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:320 W SABAL PALM PL STE 200
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3621
Practice Address - Country:US
Practice Address - Phone:407-788-6399
Practice Address - Fax:407-788-0404
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101957207Q00000X
FLME65818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014784300Medicaid
WI100283196Medicaid
FLME65818OtherMEDICAL LICENSE
FLME65818OtherMEDICAL LICENSE