Provider Demographics
NPI:1124097605
Name:SAMS, ROXANNE (ARNP)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:SAMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-1270
Mailing Address - Country:US
Mailing Address - Phone:727-785-6275
Mailing Address - Fax:
Practice Address - Street 1:1020 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3423
Practice Address - Country:US
Practice Address - Phone:727-461-1439
Practice Address - Fax:727-443-7230
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL575092363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306279100Medicaid
FL306279100Medicaid