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NPI Code Detail

MEDICARE: SAMANTHA DAWN SURACE FAMILY NURSE PRACTIT

MEDICARE: SAMANTHA DAWN SURACE FAMILY NURSE PRACTIT
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
1163W00000XRegistered Nurse468023-1NY
2363LF0000XFamily Nurse PractitionerF341222-1NY
3363L00000XNurse PractitionerAPRN11007304FL
4363LF0000XFamily Nurse PractitionerAPRN11007304FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518234111
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DAWN SURACE FAMILY NURSE PRACTIT
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-1614
Fax Number : 239-343-3695
Provider Business Practice Location Address
First Line : 2776 CLEVELAND AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-5864
Country : US
Telephone Number : 239-343-1614
Fax Number : 239-343-3695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2011
Last Update Date : 12/09/2025

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Directions to “ SAMANTHA DAWN SURACE FAMILY NURSE PRACTIT” Practice Location

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