1942350848 NPI number — DR. MARIE BERNADETTE SAMSON-JOSEPH APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942350848 NPI number — DR. MARIE BERNADETTE SAMSON-JOSEPH APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMSON-JOSEPH
Provider First Name:
MARIE
Provider Middle Name:
BERNADETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMSON
Provider Other First Name:
MARIE
Provider Other Middle Name:
BERNADETTE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, MSN, BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942350848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8579 GRAND PRIX LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33472-2736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-245-9993
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3852 NW 62ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCONUT CREEK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33073-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-429-9721
Provider Business Practice Location Address Fax Number:
954-429-9721
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  APRN3170352 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: ARNP3170352 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105252100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".