Healthcare Provider Details

I. General information

NPI: 1063273225
Provider Name (Legal Business Name): SAMANTHA ESCANDON CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 LANDINGS WAY DR APT 302
TAMPA FL
33624-3019
US

IV. Provider business mailing address

3614 LANDINGS WAY DR APT 302
TAMPA FL
33624-3019
US

V. Phone/Fax

Practice location:
  • Phone: 727-304-9000
  • Fax:
Mailing address:
  • Phone: 727-304-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-319294
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: