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General NPI Number Information
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NPI Number | 1629948237
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Entity Type | Individual
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Provider Name | ALEXIS NICOLE SAMUELS
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Gender | Female
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Dates
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Enumeration Date | 11/08/2025
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Last Update Date | 11/08/2025
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Provider Practice Location Address
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Address Line | 1590 BLOOMINGDALE AVE
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City | VALRICO
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State | FL
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Zip | 33596-6101
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Country | US
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Telephone | 703-596-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 3649 PALM CROSSING DR UNIT 102
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City | TAMPA
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State | FL
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Zip | 33613-4979
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Country | US
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Telephone | 937-620-7062
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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