Provider Demographics
NPI:1316409642
Name:FLORESTAL, MARIE SAMANTHA (NP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SAMANTHA
Last Name:FLORESTAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2601 WELLS AVE STE 141
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2000
Mailing Address - Country:US
Mailing Address - Phone:407-335-4050
Mailing Address - Fax:888-595-5746
Practice Address - Street 1:2601 WELLS AVE STE 141
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2000
Practice Address - Country:US
Practice Address - Phone:407-335-4050
Practice Address - Fax:888-595-5746
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL11000144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily