Healthcare Provider Details

I. General information

NPI: 1659235539
Provider Name (Legal Business Name): SAMANTHA SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

IV. Provider business mailing address

10830 DEAL RD
NORTH FORT MYERS FL
33917-5237
US

V. Phone/Fax

Practice location:
  • Phone: 239-839-1828
  • Fax:
Mailing address:
  • Phone: 239-839-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11042695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: