MEDICARE: MELISSA MARIE SAMUELS APRN

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	363LF0000X	Family Nurse Practitioner	11010671	FL
2	363LF0000X	Family Nurse Practitioner	GAA-NP000491	GA

General Provider Information

NPI Number	:	1134708639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARIE SAMUELS APRN

Provider Business Mailing Address
First Line	:	2994 ATLANTA RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-3655
Country	:	US
Telephone Number	:	770-435-2178
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 ROYAL PALM WAY
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4303
Country	:	US
Telephone Number	:	561-340-5788
Fax Number	:	561-340-5778

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

Provider Enumeration Date	:	04/03/2021
Last Update Date	:	08/11/2022

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