Healthcare Provider Details

I. General information

NPI: 1609489541
Provider Name (Legal Business Name): BINSEY DAWN SAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18560 N DALE MABRY HWY
LUTZ FL
33548-7900
US

IV. Provider business mailing address

9003 TARAWYND CT
ODESSA FL
33556-1724
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-7734
  • Fax: 844-971-6901
Mailing address:
  • Phone: 321-614-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9112708
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberPA9112708
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA9112708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: