MEDICARE: SAMANTHA CHAMPION

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	363AM0700X	Medical Physician Assistant		FL

General Provider Information

NPI Number	:	1265284921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA CHAMPION

Provider Business Mailing Address
First Line	:	1601 CLINT MOORE RD STE 145
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-5720
Country	:	US
Telephone Number	:	561-210-7310
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CLINT MOORE RD STE 145
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-5720
Country	:	US
Telephone Number	:	561-210-7319
Fax Number	:

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

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	05/22/2026

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Directions to “ SAMANTHA CHAMPION ” Practice Location

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