MEDICARE: SAMANTHA PERRIN

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	390200000X	Student in an Organized Health Care Education/Training Program
2	164W00000X	Licensed Practical Nurse	LN99845	MA

General Provider Information

NPI Number	:	1285208454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA PERRIN

Provider Business Mailing Address
First Line	:	269 UNION ST
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01901-1314
Country	:	US
Telephone Number	:	781-581-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 S ORANGE AVE FL 3
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3394
Country	:	US
Telephone Number	:	407-930-9551
Fax Number	:	407-604-6698

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

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	10/18/2022

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Directions to “ SAMANTHA PERRIN ” Practice Location

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