Provider Demographics
NPI:1679934921
Name:SAMPSON, GEORGETTE A (ARNP)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:A
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LANDAU ST
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8434
Mailing Address - Country:US
Mailing Address - Phone:561-707-4894
Mailing Address - Fax:
Practice Address - Street 1:77 LANDAU ST
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8434
Practice Address - Country:US
Practice Address - Phone:561-707-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302R00000X
FLARNP9236286363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner