Provider Demographics
NPI:1861077943
Name:PITT, SAMANTHA MELISSA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MELISSA
Last Name:PITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 NW 57TH CT
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5705
Mailing Address - Country:US
Mailing Address - Phone:754-204-4824
Mailing Address - Fax:
Practice Address - Street 1:6609 NW 57TH CT
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5705
Practice Address - Country:US
Practice Address - Phone:754-204-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012068363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health