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General NPI Number Information
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NPI Number | 1508681040
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Entity Type | Individual
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Provider Name | SAMERAWIT TADELE
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 4151 HUNTERS PARK LN STE 108
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City | ORLANDO
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State | FL
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Zip | 32837-3617
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Country | US
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Telephone | 407-898-2767
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Fax |
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Provider Business Mailing Address
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Address Line | 1438 SUN MEADOW DR
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City | ORLANDO
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State | FL
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Zip | 32824-5112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 11035152
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License Number State | FL
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