MEDICARE: SARAH MARIA SAMPSON CRANDALL FNP

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	363LP2300X	Primary Care Nurse Practitioner	11037146	FL

General Provider Information

NPI Number	:	1851102305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MARIA SAMPSON CRANDALL FNP

Provider Business Mailing Address
First Line	:	3740 CURTIS BLVD STE 108
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-3962
Country	:	US
Telephone Number	:	252-548-1595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 CURTIS BLVD STE 108
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-3962
Country	:	US
Telephone Number	:	321-633-5500
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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