Provider Demographics
NPI:1942350848
Name:SAMSON-JOSEPH, MARIE BERNADETTE (APRN)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:BERNADETTE
Last Name:SAMSON-JOSEPH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:BERNADETTE
Other - Last Name:SAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MSN, BSN, RN
Mailing Address - Street 1:8579 GRAND PRIX LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2736
Mailing Address - Country:US
Mailing Address - Phone:754-245-9993
Mailing Address - Fax:
Practice Address - Street 1:3852 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2140
Practice Address - Country:US
Practice Address - Phone:954-429-9721
Practice Address - Fax:954-429-9721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3170352363LG0600X
FLARNP3170352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ64315Medicare UPIN
FL469663Medicare PIN