Provider Demographics
NPI:1093196800
Name:AUSTIN, SAMANTHA DENISE (ARPN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:DENISE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:DENISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5308 W IRLO BRONSON HWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4754
Mailing Address - Country:US
Mailing Address - Phone:407-390-9431
Mailing Address - Fax:407-841-5705
Practice Address - Street 1:5308 W IRLO BRONSON HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4754
Practice Address - Country:US
Practice Address - Phone:407-390-9431
Practice Address - Fax:407-841-5705
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2020-07-23
Deactivation Date:2018-07-25
Deactivation Code:
Reactivation Date:2018-10-24
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9326665363LF0000X
FLARNP9326665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9326665OtherFL MEDICAL LICENSE