NPIMap

Individual provider Active NPI

Samantha Shoshana Petrillo, AGACNP-BC

  • Adult Health Nurse Practitioner
  • Fort Lauderdale, FL
National Provider Identifier
1003782228
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11042570 Issued in FL
Practice address
1601 S Andrews Ave FL 3
Fort Lauderdale, FL 33316-2509
Phone
(954) 763-6655
Fax
(954) 763-6799
NPI assigned
Oct 14, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 11042570 FL
Adult Health Nurse Practitioner 363LA2200X APRN11042570 FL Primary

Addresses

Primary practice location

1601 S Andrews Ave FL 3
Fort Lauderdale, FL 33316-2509

Mailing address

1608 SE 3Rd Ave FL 3
Fort Lauderdale, FL 33316-2564
Phone (954) 763-6655

Other identifiers 1

IdentifierTypeStateIssuer
129062900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251122000957 FL Practitioner - Nurse Practitioner 5395237846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Miami, LM Miller School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Broward Hospital DistrictGroup PAC ID 3577472422, 192 clinicians

Practice addresses (Care Compare)

1601 S Andrews Ave
FL 3
Fort Lauderdale, FL 33316-2509
Phone (954) 468-4069

Hospital & facility affiliations

  • Broward Health Medical Center Hospital, Fort Lauderdale, FL, CCN 100039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11042570FLMDAcute Care Nurse Practitioner
APRN11042570FLMDAdult Health Nurse Practitioner

Practice roles (4 of 5)

OrganizationSpecialtyStatusNew patients
North Broward Hospital District CurrentSince Jan 12, 2026 Accepting new patients
North Broward Hospital District CurrentSince Jan 12, 2026 Accepting new patients
North Broward Hospital District Past Accepting new patients
North Broward Hospital District Past Accepting new patients

Locations

1608 SE 3rd Ave
Fl 3
Ft Lauderdale, FL 33316

1601 S Andrews Ave
Fl 3
Ft Lauderdale, FL 33316
Phone (954) 320-3380

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

Networks

  • Freedom Health HMO Network

Organizations & group practices 27

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 27

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1003782228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 SE 3RD AVE FL 3",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162564",
            "telephone_number": "954-763-6655",
            "fax_number": "954-763-6799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 S ANDREWS AVE FL 3",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162509",
            "telephone_number": "954-763-6655",
            "fax_number": "954-763-6799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLO",
        "first_name": "SAMANTHA",
        "middle_name": "SHOSHANA",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-14",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11042570",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11042570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129062900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.