Healthcare Provider Details

I. General information

NPI: 1164241196
Provider Name (Legal Business Name): JAUNATHEN SAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 PALM BEACH LAKES BLVD STE 203
WEST PALM BEACH FL
33409-3508
US

IV. Provider business mailing address

1897 PALM BEACH LAKES BLVD STE 203
WEST PALM BEACH FL
33409-3508
US

V. Phone/Fax

Practice location:
  • Phone: 561-427-5536
  • Fax:
Mailing address:
  • Phone: 561-427-5536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: