Healthcare Provider Details

I. General information

NPI: 1134051659
Provider Name (Legal Business Name): SAMARA SACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW 27TH AVE STE 609
MIAMI FL
33135-2968
US

IV. Provider business mailing address

330 SW 27TH AVE STE 609
MIAMI FL
33135-2968
US

V. Phone/Fax

Practice location:
  • Phone: 305-851-8980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11046892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: