Provider Demographics
NPI:1215254875
Name:SAMUEL, ANN M (APRN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CELEBRATION PL STE 306
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5436
Mailing Address - Country:US
Mailing Address - Phone:407-303-4855
Mailing Address - Fax:407-303-4404
Practice Address - Street 1:410 CELEBRATION PL STE 306
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5436
Practice Address - Country:US
Practice Address - Phone:407-303-4855
Practice Address - Fax:407-303-4404
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9232980163W00000X
FLAPRN9232980363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse