Healthcare Provider Details

I. General information

NPI: 1295395135
Provider Name (Legal Business Name): JENNIFER L SAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 E GRANT ST STE A
ORLANDO FL
32822-1668
US

IV. Provider business mailing address

6015 E BROWN RD
MESA AZ
85205-4452
US

V. Phone/Fax

Practice location:
  • Phone: 407-367-4706
  • Fax:
Mailing address:
  • Phone: 407-367-4706
  • Fax: 321-203-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341474
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number90695
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11002670
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14272277-4405
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70107417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: