Provider Demographics
NPI:1235599408
Name:GARGUILO, SAMANTHA (PA)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:GARGUILO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14530 S MILITARY TRL
Mailing Address - Street 2:STE A1-A5
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3706
Mailing Address - Country:US
Mailing Address - Phone:561-381-0260
Mailing Address - Fax:
Practice Address - Street 1:2323 S ORANGE AVE STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3059
Practice Address - Country:US
Practice Address - Phone:407-418-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018927-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant