MEDICARE: DR. SAMANTHA MONTEALEGRE DNP, PMHNP-BC, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	RN9293460	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11015430	FL

General Provider Information

NPI Number	:	1073052924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA MONTEALEGRE DNP, PMHNP-BC, IBCLC

Provider Business Mailing Address
First Line	:	12430 SW 2ND ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-2704
Country	:	US
Telephone Number	:	954-547-7356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 S CONGRESS AVE STE 455
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6559
Country	:	US
Telephone Number	:	561-336-4790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	12/11/2022

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