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General NPI Number Information
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NPI Number | 1912577008
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Entity Type | Individual
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Provider Name | SAMUEL ALTIDOR ARNP
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Gender | Male
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 2850 S MAIN ST STE 104
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City | HIGH POINT
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State | NC
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Zip | 27263-1900
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Country | US
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Telephone | 336-283-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 5380 NW 55TH BLVD APT 101
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3702
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Country | US
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Telephone | 954-701-3789
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11015076
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5016250
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License Number State | NC
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