Provider Demographics
NPI:1225915911
Name:LOUIGENE, SAMORA
Entity type:Individual
Prefix:
First Name:SAMORA
Middle Name:
Last Name:LOUIGENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMORA
Other - Middle Name:
Other - Last Name:SINCOUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4262 SW OBLIQUE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4262 SW OBLIQUE ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7200
Practice Address - Country:US
Practice Address - Phone:561-574-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9512359364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine