MEDICARE: SAMANTHA EVE CERISIER BSN, RN

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

General Provider Information

NPI Number	:	1376499764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA EVE CERISIER BSN, RN

Provider Business Mailing Address
First Line	:	779 NW FLORESTA DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1508
Country	:	US
Telephone Number	:	561-713-4886
Fax Number	:

Provider Business Practice Location Address
First Line	:	779 NW FLORESTA DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1508
Country	:	US
Telephone Number	:	561-713-4886
Fax Number	:

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

Provider Enumeration Date	:	03/07/2026
Last Update Date	:	03/07/2026

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