Fawaz, Samar

Fawaz, Samar is an individual health care provider with primary practice located at 175 Villa Nueva Ave Ne , Palm Bay FL 32907-2595. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Fawaz, Samar can be contacted via phone (313) 574-2965.

Contact Information

Primary practice address
175 Villa Nueva Ave Ne Palm Bay FL 32907-2595
Phone: (313) 574-2965
Fax: (321) 603-3560
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5601008292 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9111341 Florida

Profile Details

NPI number 1548779580
LBN Legal business name Fawaz, Samar
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2017
Last updated Oct 31st, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548779580 NPPES
Florida Other P02091188 RRMEDICARE PTAN
Florida MEDICAID 101048700 RRMEDICARE PTAN
Florida Other JL436Z RRMEDICARE PTAN

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