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General NPI Number Information
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NPI Number | 1942866926
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Entity Type | Individual
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Provider Name | SAMANTHA ALICE WARDAK
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Gender | Female
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 16040 PINES BLVD # P103
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1171
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Country | US
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Telephone | 954-301-4988
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Fax |
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Provider Business Mailing Address
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Address Line | 11610 SW 42ND ST UNIT 225
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City | MIRAMAR
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State | FL
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Zip | 33025-8077
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Country | US
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Telephone | 920-382-0299
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115962
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | GA
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