Provider Demographics
NPI:1386808814
Name:SANTIAGO, DORIS N (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:N
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 BARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4620
Mailing Address - Country:US
Mailing Address - Phone:863-439-2428
Mailing Address - Fax:
Practice Address - Street 1:1008 BARRETT AVE
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4620
Practice Address - Country:US
Practice Address - Phone:863-439-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2548362163W00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL222QOOOOOXMedicaid