MEDICARE: SAMANTHA WELT PA-C

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	9564	FL

General Provider Information

NPI Number	:	1205652724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA WELT PA-C

Provider Business Mailing Address
First Line	:	11948 BALM RIVERVIEW RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-6601
Country	:	US
Telephone Number	:	813-656-9553
Fax Number	:

Provider Business Practice Location Address
First Line	:	11948 BALM RIVERVIEW RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-6601
Country	:	US
Telephone Number	:	813-656-9553
Fax Number	:

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

Provider Enumeration Date	:	11/30/2024
Last Update Date	:	05/23/2026

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