Healthcare Provider Details

I. General information

NPI: 1083097406
Provider Name (Legal Business Name): SAMUEL DEFIGARELLI I M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 N DAVIS HWY STE 5
PENSACOLA FL
32503-2303
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 850-610-8209
  • Fax: 844-388-6186
Mailing address:
  • Phone: 727-322-3439
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME149910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: