Healthcare Provider Details

I. General information

NPI: 1184018764
Provider Name (Legal Business Name): SAMANTHA LLUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 SW 98TH AVE
MIAMI FL
33165-5135
US

IV. Provider business mailing address

4352 SW 98TH AVE
MIAMI FL
33165-5135
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-5285
  • Fax:
Mailing address:
  • Phone: 786-663-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11039271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: