Provider Demographics
NPI:1912577008
Name:ALTIDOR, SAMUEL (ARNP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:ALTIDOR
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 NW 55TH BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3702
Mailing Address - Country:US
Mailing Address - Phone:954-701-3789
Mailing Address - Fax:
Practice Address - Street 1:2850 S MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-1900
Practice Address - Country:US
Practice Address - Phone:336-283-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015076363LF0000X
NC5016250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily