Healthcare Provider Details

I. General information

NPI: 1770853038
Provider Name (Legal Business Name): AIDA SAMSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AIDA BAJRAMOVIC PA-C

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 S TAMIAMI TRL STE 200
SARASOTA FL
34239-5142
US

IV. Provider business mailing address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3509
US

V. Phone/Fax

Practice location:
  • Phone: 941-952-9223
  • Fax: 941-955-0642
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: