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NPI Code Detail

MEDICARE: DECHONE SAMUELS NP

MEDICARE: DECHONE SAMUELS NP
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
1363L00000XNurse PractitionerSP018858PA
2363L00000XNurse PractitionerAPRN9403675FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083104335
Entity Type Code : Individual
Provider Name (Legal Business Name) : DECHONE SAMUELS NP
Provider Business Mailing Address
First Line : 6108 MARTA DR
Second Line :
City : TAMPA
State : FL
Zip : 33617-1337
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2202 W OAK AVE
Second Line :
City : PLANT CITY
State : FL
Zip : 33563-7222
Country : US
Telephone Number : 386-562-4899
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2018
Last Update Date : 08/14/2023

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