Provider Demographics
NPI:1144528522
Name:SAMPSON, MICHAEL LEE (ARNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:STE 203
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5162
Mailing Address - Country:US
Mailing Address - Phone:407-265-7775
Mailing Address - Fax:407-265-2266
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:STE 203
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5162
Practice Address - Country:US
Practice Address - Phone:407-265-7775
Practice Address - Fax:407-265-2266
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9217644363A00000X, 363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004177300Medicaid
FLARNP9217644OtherMEDICAL LICENSE
FLEY323YMedicare PIN