Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 11013839 | FL |
NPI | 1023687662 |
---|---|
Provider Name | Samantha Leute |
First Address | Fort Lauderdale, FL 33301-2334 |
Second Address | Miami, FL 33136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 20/12/2021 |