Healthcare Provider Details

I. General information

NPI: 1588505663
Provider Name (Legal Business Name): SAMANTHA HEISER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 N FEDERAL HWY
FT LAUDERDALE FL
33308-1427
US

IV. Provider business mailing address

1205 HIDDEN STREAM CT
ABINGDON MD
21009-3004
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-2472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: