Provider Demographics
NPI:1629931597
Name:PAXSON, LORNA SANTIAGO
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:SANTIAGO
Last Name:PAXSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84874 FALL RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-0318
Mailing Address - Country:US
Mailing Address - Phone:904-610-5602
Mailing Address - Fax:
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-610-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-06
Last Update Date:2025-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11043988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily