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General NPI Number Information
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NPI Number | 1699534610
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Entity Type | Individual
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Provider Name | CRYSTAL MARIE SAMMARCO
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Gender | Female
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 1900 TAMIAMI TRL UNIT 109
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-2174
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Country | US
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Telephone | 941-743-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 850 JARVIS ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-3506
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Country | US
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Telephone | 941-628-9471
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AST1300
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License Number State | FL
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