Provider Demographics
NPI:1083961841
Name:GILLES, SAMORAH JB (ARNP)
Entity Type:Individual
Prefix:
First Name:SAMORAH
Middle Name:JB
Last Name:GILLES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SAMORAH
Other - Middle Name:
Other - Last Name:JEAN-BAPTISTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 198483
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8483
Mailing Address - Country:US
Mailing Address - Phone:954-583-9995
Mailing Address - Fax:954-321-3832
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:954-583-9995
Practice Address - Fax:954-321-3832
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9192157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily