Provider Demographics
NPI:1730176744
Name:DENARDO, SAMUEL R (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:DENARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S
Other - Middle Name:RICHARD
Other - Last Name:DENARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:7720 US HIGHWAY 98 W STE 110
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7231
Practice Address - Country:US
Practice Address - Phone:850-278-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147449207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79278Medicare UPIN
N87110003Medicare PIN