Provider Demographics
NPI:1770080046
Name:WANNOS, SAMANTHA ANNE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANNE
Last Name:WANNOS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 PICKERELL PL
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2206
Mailing Address - Country:US
Mailing Address - Phone:727-916-0358
Mailing Address - Fax:
Practice Address - Street 1:3131 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-726-8871
Practice Address - Fax:727-726-8571
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9282492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHW88JOtherFLORIDA BLUE