MEDICARE: SAMANTHA LAUREN MARCOLINA MSN, APRN, AGPCNP-C

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	363L00000X	Nurse Practitioner	11033692	FL

General Provider Information

NPI Number	:	1902636897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LAUREN MARCOLINA MSN, APRN, AGPCNP-C

Provider Business Mailing Address
First Line	:	6560 SAND LAKE SOUND RD UNIT 6108
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7649
Country	:	US
Telephone Number	:	267-625-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	7524 W SAND LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5110
Country	:	US
Telephone Number	:	407-426-4801
Fax Number	:

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

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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