Provider Demographics
NPI:1184489262
Name:BRILMYER, SAMANTHA DEAN (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DEAN
Last Name:BRILMYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6279 ROADSTEAD CT
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2238
Mailing Address - Country:US
Mailing Address - Phone:219-577-3846
Mailing Address - Fax:
Practice Address - Street 1:2106 S LOIS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5659
Practice Address - Country:US
Practice Address - Phone:813-844-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031279363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner