Provider Demographics
NPI:1114455813
Name:SAMUELS, LETECIA JAMES
Entity Type:Individual
Prefix:
First Name:LETECIA
Middle Name:JAMES
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 692406
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-2406
Mailing Address - Country:US
Mailing Address - Phone:407-433-5720
Mailing Address - Fax:
Practice Address - Street 1:12620 BELROSE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8566
Practice Address - Country:US
Practice Address - Phone:407-717-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234784253Z00000X
FLRN9366496163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No253Z00000XAgenciesIn Home Supportive Care