Healthcare Provider Details

I. General information

NPI: 1851708127
Provider Name (Legal Business Name): SAMANTHA DELORIMIER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 N STATE ROAD 7
MARGATE FL
33063-7011
US

IV. Provider business mailing address

1560 SAWGRASS CORPORATE PKWY STE 220
SUNRISE FL
33323-2855
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-3664
  • Fax:
Mailing address:
  • Phone: 305-623-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: