MEDICARE: MICHAEL LEE SAMPSON ARNP

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	363A00000X	Physician Assistant	ARNP9217644	FL
2	363L00000X	Nurse Practitioner	ARNP9217644	FL
3	363LA2200X	Adult Health Nurse Practitioner	ARNP9217644	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ARNP9217644	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1144528522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEE SAMPSON ARNP

Provider Business Mailing Address
First Line	:	515 W STATE ROAD 434
Second Line	:	STE 203
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5162
Country	:	US
Telephone Number	:	407-265-7775
Fax Number	:	407-265-2266

Provider Business Practice Location Address
First Line	:	515 W STATE ROAD 434
Second Line	:	STE 203
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5162
Country	:	US
Telephone Number	:	407-265-7775
Fax Number	:	407-265-2266

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

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	11/15/2016

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