Healthcare Provider Details

I. General information

NPI: 1811549769
Provider Name (Legal Business Name): SAMANTHA SHANNON DELAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W GANDY BLVD
TAMPA FL
33611-2931
US

IV. Provider business mailing address

5034 ROCKY COAST PL
PALMETTO FL
34221-1490
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax: 813-749-8370
Mailing address:
  • Phone: 901-606-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344754
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: