Individual
JOMARY SANTIAGO ILLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
395 W 42ND ST, HIALEAH, FL 33012-3914
(786) 340-7538
Mailing address
395 W 42ND ST, HIALEAH, FL 33012-3914
(786) 340-7538
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
11026344
FL
363LA2200X
Adult Health Nurse Practitioner
11026344
FL
363LC1500X
Community Health Nurse Practitioner
11026344
FL
363LG0600X
Gerontology Nurse Practitioner
11026344
FL
363LP2300X
Primary Care Nurse Practitioner
11026344
FL
Other
Enumeration date
10/30/2023
Last updated
10/30/2023
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