Healthcare Provider Details

I. General information

NPI: 1770080046
Provider Name (Legal Business Name): SAMANTHA ANNE WANNOS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 N MCMULLEN BOOTH RD
CLEARWATER FL
33761
US

IV. Provider business mailing address

3545 PICKERELL PL
NEW PORT RICHEY FL
34655-2206
US

V. Phone/Fax

Practice location:
  • Phone: 727-726-8871
  • Fax: 727-726-8571
Mailing address:
  • Phone: 727-916-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9282492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: