Provider Demographics
NPI:1013635150
Name:BATTLE, SAMUEL O
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:O
Last Name:BATTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WEST CYPRESS
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4159
Mailing Address - Country:US
Mailing Address - Phone:813-207-7769
Mailing Address - Fax:813-200-2080
Practice Address - Street 1:4300 WEST CYPRESS
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4159
Practice Address - Country:US
Practice Address - Phone:813-207-7769
Practice Address - Fax:813-200-2080
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9356493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health