Healthcare Provider Details

I. General information

NPI: 1245007004
Provider Name (Legal Business Name): SAMANTHA CHRISTINE URQUIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

3120 NW 100TH CT
DORAL FL
33172-5916
US

V. Phone/Fax

Practice location:
  • Phone: 703-955-1001
  • Fax:
Mailing address:
  • Phone: 703-955-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number9477622
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11030484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: