Healthcare Provider Details

I. General information

NPI: 1417656042
Provider Name (Legal Business Name): SAMANTHA DAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 RINEHART RD
LAKE MARY FL
32746-2551
US

IV. Provider business mailing address

8145 OAK PARK RD
ORLANDO FL
32819-3206
US

V. Phone/Fax

Practice location:
  • Phone: 305-899-3230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11039847
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number155311
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9513476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: