Sama Mah Fombu, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9268150 Issued in FL

Practice address

3061 SW 160TH Ave Ste 107
Miramar, FL 33027-4213

Phone

(754) 204-0952

NPI assigned

Jan 18, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1579305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579305600000",
    "number": "1245860220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3061 SW 160TH AVE STE 107",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330274213",
            "telephone_number": "754-204-0952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3061 SW 160TH AVE STE 107",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330274213",
            "telephone_number": "754-204-0952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMBU",
        "first_name": "SAMA",
        "middle_name": "MAH",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-18",
        "last_updated": "2020-01-18",
        "certification_date": "2020-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9268150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NOT USING INSURERS",
            "identifier": "9268150",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "cynthia_mah4@hotmail.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "cynthia_mah4@hotmail.com",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "cynthia_mah4@hotmail.com",
            "address_1": "3061 SW 160th Ave Ste 107",
            "city": "Miramar",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330274213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in Miramar, FL
• Providers in Miramar, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.