Provider Demographics
NPI:1235781030
Name:DUNLOP, SAMUEL WOLF (NP-C)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WOLF
Last Name:DUNLOP
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MEMORIAL CIR STE C
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5054
Mailing Address - Country:US
Mailing Address - Phone:386-615-3500
Mailing Address - Fax:386-615-3505
Practice Address - Street 1:500 MEMORIAL CIR STE C
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5054
Practice Address - Country:US
Practice Address - Phone:386-615-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily