Provider Demographics
NPI:1871999623
Name:SANTIAGO, AIDA L (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278984
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-341-7500
Mailing Address - Fax:585-341-7510
Practice Address - Street 1:919 WESTFALL RD STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2628
Practice Address - Country:US
Practice Address - Phone:585-341-7500
Practice Address - Fax:585-341-7510
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY306904363LA2200X
NY306904-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health