MEDICARE: LESLIE E. SAMO ARNP

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	363LF0000X	Family Nurse Practitioner	1726622	FL

General Provider Information

NPI Number	:	1811138704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE E. SAMO ARNP

Provider Business Mailing Address
First Line	:	8 CADILLAC DR
Second Line	:	STE. 250
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5087
Country	:	US
Telephone Number	:	615-425-4200
Fax Number	:	615-425-4271

Provider Business Practice Location Address
First Line	:	2556 ENTERPRISE RD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7939
Country	:	US
Telephone Number	:	386-456-0289
Fax Number	:	389-456-0376

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

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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