Healthcare Provider Details

I. General information

NPI: 1922932557
Provider Name (Legal Business Name): SAMANTHA FLORES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 STATE HIGHWAY 100 E STE 107
PALM COAST FL
32164-2738
US

IV. Provider business mailing address

48 BARRINGTON DR
PALM COAST FL
32137-8861
US

V. Phone/Fax

Practice location:
  • Phone: 954-895-3091
  • Fax:
Mailing address:
  • Phone: 954-895-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: