Healthcare Provider Details

I. General information

NPI: 1962328369
Provider Name (Legal Business Name): SAMANTHA TABONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2572 COMMERCE PKWY
NORTH PORT FL
34289-9332
US

IV. Provider business mailing address

11 GEORGES PL
FREDONIA NY
14063-2122
US

V. Phone/Fax

Practice location:
  • Phone: 941-888-5839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: