Provider Demographics
NPI:1407680515
Name:SANTIAGO, ROLANDO JR (APRN)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:SANTIAGO
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8900
Mailing Address - Country:US
Mailing Address - Phone:727-322-1054
Mailing Address - Fax:
Practice Address - Street 1:1955 1ST AVE N STE 104
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8941
Practice Address - Country:US
Practice Address - Phone:727-322-2925
Practice Address - Fax:727-290-6018
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily